Parent–child play: A mental health promotion strategy for all children

Parent–child play: A mental health promotion strategy for all children

Sarah Seekamp and Ben Rogers
4 December 2019

This webinar discussed how practitioners can use child-led play to assist families to improve parent–child relationships and child mental health.

Family in the park

Slide outline: Parent–child play: A mental health promotion strategy for all children

1. Parent–child play: A mental health promotion strategy for all children

Sarah Seekamp and Ben Rogers
CFCA Emerging Minds Webinar  4 December 2019
Parent–child play: A mental health promotion strategy for all children

2. Ben Rogers and Sarah Seekamp
Occupational Therapists

3. Acknowledgements

Emerging Minds and CFCA recognise and pay respect to Aboriginal and Torres Strait Islander peoples, their ancestors and the Elders past, present and future from the different First Nations across this country.
We acknowledge the importance of connection to land, culture, spirituality, ancestry, family and community for the wellbeing of all Aboriginal and
Torres Strait Islander children and their families.

4. Webinar series

2019/20 Emerging Minds series: Focus on infant and child mental health.

Future webinars:

  • Child-focused supervision. What does this mean and how does it work?
  • Working with Aboriginal children and families in mainstream services.
  • Cultural considerations when working with children and families.

5. Housekeeping

  • Send through your questions via the chat box at any time during the webinar.
  • Let us know if you don’t want your question published on the online forum following the presentation.
  • All our webinars are recorded.
  • The slides are available in the handout section of Gotowebinar.
  • The audio and transcript will be posted on our website and YouTube channel in the coming week.

6. Presenters

  • Sarah Seekamp: Occupational Therapist
  • Ben Rogers: Occupational Therapist
  • Chris Dolman (Facilitator): Senior Workforce Development Officer, Emerging Minds

7. Legge quote

‘Children who have a consistently responsive and nurturing relationship with their Parent*, typically experience better mental health and are more resilient.’

(Legge, 2018)

8. Strengthening the relationship 

Child-led play + Responsive Parent = strengthened relationship

9. Your role in this universal mental health promotion strategy?

10. This webinar will focus on:

  • Defining child led play & its benefits
  • How parents can participate in child-led play
  • Exploring behaviour change theory
  • Providing practical ways to support parents

11. Practice resources:

Alt text: Screenshot of the Emerging MInds Parent-child play conversation guide

Alt text: Screenshot of the Emerging MInds Parent-child play practice resource

12. Evidence Based Practice Lens

Alt text: A Venn diagram showing how Best Research Evidence, Patient Values and Clinical Expertise cross over each other. Where they all cross over in the centre is the evidence based practice lens. I.e. an evidence based practice lens incorporates these three elements.

13. What is child-led play?

Free, child directed play, where the child is the decision maker, moving at their own pace, discovering their own areas of interest, and ultimately engaging fully in the passions they wish to pursue.

(Ginsburg, 2007)

14.  What is child-led play:

  • The child explores their environment freely without restriction.
  • They make the rules & decisions without direction or intervention. 
  • The child chooses what to play with & who to play with.
  • The play will look different depending on the child’s individual differences.

15. What are the benefits for the child?

  • Children’s freedom to express themselves through play is fundamental to their cognitive, physical, social, and emotional wellbeing (Ginsburg, 2007).
  • Children whose parents regularly engage in play with them are less likely to develop mental health difficulties such as anxiety, depression, aggression, and sleep problems (Goldstein, 2012).
  • An effective way for children to negotiate their own interests and place in their broader environment, increasing confidence and resilience (Brussoni et al., 2015; Fearn & Howard, 2011). 

16. The role of the parent:

  • The parent aims to see the world through their child’s eyes.
  • The parent conveys their love and delight in their child.
  • The parent ensures that the environment is safe for the child’s free exploration.
  • Key things for the parent to avoid during this play include:
    • Using play as a reward
    • Interruptions
    • Multi-tasking
    • Teaching and correction.

17. What are the benefits for the parent?

  • Parents report getting to know their child as their own person, with their own interests and values.
  • This deeper level of understanding of the child supports attunement to their needs (Ginsburg, 2007).
  • Provides parents with a focus for supporting their child’s social and emotional wellbeing.
  • Parent anchoring thoughts and experiences ‘in the moment’ opposed to focusing on current stressors.

18. Key learning:

  • The child explores their environment freely without restriction
  • The parent is fully present, sharing love and delight in the child's experiences
  • Play is fundamental to their cognitive, physical, social, and emotional wellbeing 
  • Parental perspective shifts to the strengths and interest of the child 

19. Part 2: Translating knowledge into practice 

  • Exploring behaviour change theory as a tool to support families to act
  • Providing practical ways to support parents in child led play

20. Who might this approach suit?

  • Parents and children who will benefit from strengthening their relationship
  • Parents who need support to see their child’s perspective & strengths
  • Parents who due to their own adversities find it hard to prioritise their child’s needs
  • Children and families living through stressful times
  • All families

21. Take a moment to reflect on a family where child-led play might be useful.

22. The Health Iceberg:

Case example 

  • Above the surface:
    • Child referred to the service with a developmental delay.
    • Parent had been reported to have difficulty connecting with child. 
  • Below the surface:
    • The home environment had limited physical resources, routines and social supports for family.
    • Domestic violence, maternal mental health, unstable housing and financial concerns.

(Talbot and Verrinder, 2014, p.16)

23. The stages of behavior change

  • Stages of behaviour change
  • Maintenance - works to sustain the behavior change
  • Action - practices the desired behavior
  • Preparation - intends to take action
  • Contemplation - aware of the problem and of the desired behavior change
  • Pre-contemplation - unaware of the problem

(Prochaska, 2008)

24. Key learning:

  • This approach is all beneficial for all families
  • Important to understand the factors that can impact behavior change
  • Important to understand the stage of readiness for change
  • Opportunity to take this learning and reflect your own client

25. Introducing Child-led play to families

  • Connect with family
  • Strengthen capacity
  • Making a plan
  • Action & reflection

26. Connecting with family:

  • Connect so the parent feels safe and supported.
  • Involves listening, remaining curious and working collaboratively. 
  • In order to work with a family we need to truly understand them. 
  • Supports understanding of the strengths and vulnerabilities of the parent and family.

 

27. Strengthen capacity for child-led play: Knowledge

  • Build knowledge and education around child-led play
  • Knowledge of previous play experiences
  • Knowledge to support an informed decision

 

28. Strengthen capacity for child-led play: Knowledge (cont..)

  • What support does the parent require from us?
  • The focus is on building on the strengths of the parent.
  • How can we model skills for the parent?

29. The stages of behavior change (cont)

  • Stages of behaviour change
  • Maintenance - works to sustain the behavior change
  • Action - practices the desired behavior
  • Preparation - intends to take action
  • Contemplation - aware of the problem and of the desired behavior change
  • Pre-contemplation - unaware of the problem

(Prochaska, 2008)

30. Planning for success (preparation phase)

  • Making a plan that feels realistic for the family.
  • Setting a specific goal: when, where, how long?
  • Finding time and space.

31. Goal examples:

This week I will play with Joe on 2 days after school for 15 minutes each time.

3 times a week, when Isaac plays outside, I will ask if he would like me to play with him. I will follow his lead if he wants me to join him and play for at least 15 minutes.

When I put Emily on the floor, I will provide her with a range of toys and sit with her for 5 minutes.  In this time I will focus on which toys she seeks out and what she seems to enjoy and try describing some of her actions to her.

32. Making a plan:

  • What might get in the way?
  • What supports are available?

33. Guide for practitioners:

What might get in the way of our playtime?

To overcome this, I could: 

To help keep me motivated towards achieving this shared playtime I can focus on: 

To help me remember to have our playtime I will: 

The things/people that can help make this plan possible are:

34. Action & Reflection:

Role of the practitioner

Providing support through accountability and  interest /care

Facilitating reflection and action cycle

35. Key messages:

  • Child-led play is an important health promotion strategy for all
  • Behaviour change theory can be helpful in enabling families to act
  • Strengthens the parent–child relationship
  • Practitioners need to tailor their support to the family’s context

36. Practice resources (cont..)

Alt text: Screenshot of the Emerging MInds Parent-child play conversation guide

Alt text: Screenshot of the Emerging MInds Parent-child play practice resource

37. Questions

38. A quote that helps shape the importance of promoting child-led play

‘When you asked me what I did in school today    and  I say, “I just played.” Please don’t misunderstand me. For you see, I am learning as I play. I am learning to enjoy and be successful in my work.  Today I am a child and my work is play.’

Anita Wadley, 1974. 

39. References:

  • Brussoni, M., Gibbons, R., Gray, C., Ishikawa, T., Sandseter, E. B., Bienenstock, A., Chabot, G., Fuselli, P., Herrington, S., Janssen, I., Pickett, W., Power, M., Stanger, N., Sampson, M., … Tremblay, M. S. (2015). What is the relationship between risky outdoor play and health in children? A systematic review. International Journal of Environmental Research and Public Health, 12(6), 6423-6454. doi:10.3390/ ijerph120606423
  • Fearn, M. & Howard, J. (2012). Play as a resource for children facing adversity: An exploration of indicative case studies. Children & Society, 26(6), 456-468. doi: 10.1111/ j.1099-0860.2011.00357
  • Ginsburg, K. R. (2007). The importance of play in promoting healthy child development and maintaining strong parent-child bonds. Retrieved from http://pediatrics. aappublications.org/content/pediatrics/119/1/182.full.pdf
  • Goldstein, J. (2012). Play in children’s development, health and well-being. Retrieved from www.digitalcraft.wdka.nl/mediawiki/images/4/4e/Play-in-children-s-development-health-and-well-being-feb-2012.pdf
  • Prochaska, J. J., Spring, B., & Nigg, C. R. (2008). Multiple health behavior change research: an introduction and overview. Preventive medicine, 46(3), 181-188.
  • Talbot, L., & Verrinder, G. (2014). Evolve Resources for Promoting Health: The Primary Health Care Approach. Elsevier Health Sciences.

40. Continue the conversation

Do you have any further questions? 

Please submit questions or comments on the online forum following today’s webinar:
aifs.gov.au/cfca/news-discussion

Audio transcript: Parent–child play: A mental health promotion strategy for all children

Audio transcript (Edited)

MR DOLMAN: Good afternoon everyone and welcome to today's webinar, Parent-child Play: A mental health promotion strategy for all children, produced by Child Family Community Australia and Emerging Minds. Hi there, my name is Chris Dolman, I am a senior workforce development officer here at Emerging Minds, the National Workforce Centre for Child Mental Health and I'm really delighted to be a part of this presentation today. In this presentation we will be discussing an approach to playtime known as child-led play and how parents can participate in this type of play in a way that encourages the parent to follow the child's choices and leads and prompts during play time without teaching the child and without correcting the child. And how this can be used as a mental health promotion strategy in a variety of settings.

I'm just going to briefly look at the learning objectives now so you sort of know what's ahead in the next hour and yes so during this webinar we'll be speaking about themes and topics that will assist practitioners to interact with families in universal health and education and community services including early childhood, education and care settings. We'll be describing how practitioners can play an important role in promoting child-led play as a mental health promotion strategy for all children, be outlining how practitioners can support parents to use play with their child to gain insights into their relationship with their child and their child's strengths and what's important to children and their vulnerabilities. We'll be talking a bit about how play can be a mechanism for practitioners to begin conversations about the hopes that parents have for their relationships with their children, and you know, increase parents' agency in making positive changes in their family life. And also you know we'll be providing some strategies that develop the resilience of children and can have positive effects, positive impacts on their long term social and emotional wellbeing.

But as we proceed I'd like to – well both Emerging Minds and CFCA wish to recognise and pay respect to Aboriginal and Torres Strait Islander peoples and their ancestors and the Elders past, present and future from the different First Nations right across this country. We acknowledge the importance of connection to land and culture, spirituality, ancestry, family and community for the wellbeing of all Aboriginal and Torres Strait Islander children and their families as well. This webinar today is the third in a series of six focused on infant and child mental health. It's being facilitated in partnership between CFCA and Emerging Minds over 2019 and 2020. The next couple are focused around child focused supervision, working with Aboriginal children and families in mainstream services, and also cultural considerations when working with children and families. The first of those is coming up in February and we'll be letting you know of the dates of the others as we proceed.

Before I proceed as well just so there's a few kind of housekeeping things to mention. I guess you know one of the core functions of the CFCA information exchange is to share knowledge of course, so I'd really like to invite everyone to submit questions via the chat box on your screen at any time during the webinar and we hope to respond to your questions at the end of this presentation. Of course if we don't get to any of those questions they may be published along with your first name on the CFCA website and there will be a response provided by our presenters today to those as well. So please let us know if you don't want your question or your first name published on our website. And we'd also like to really invite you to continue the conversation we begin here today so to make this happen we've set up a forum on the CFCA website where you can discuss some of the ideas and issues raised or submit other questions for our presenters, and also access some links to related resources as well. We'll send you a link to this forum at the end of today's presentation. And of course you know as you leave this webinar there will be a short survey that will open in a new window, we'd love if you could provide some feedback, that helps us get better at what we do.

So please remember that this webinar is being recorded and the audio and transcript and slides, they'll all be made available on the CFCA website and the CFCA YouTube channel soon. So that's quite an introduction but it's my pleasure to do some other introductions and that's to introduce our presenters today, Sarah Seekamp and Ben Rogers. Sarah and Ben are both occupational therapists and with a keen interest in this theme and I thought I'd invite them to speak a bit to that interest and yes Sarah, so I was wondering for you, and I'll ask you this question as well Ben, but perhaps starting with you Sarah. What is that's captured your interest in terms of this particular area of practice?

MS SEEKAMP: Sure, thanks Chris. I guess for me you know with the knowledge that we're seeing more and more childhood anxiety and depression presenting, I think that we really need to increasingly look at our investments in mental health promotion for children. And I think that child-led play and parental participation in this play, what I really love about that is it does present us with a mental health promotion tool but it's a tool that is really accessible for families, and also it's very child centred. You know the strategies are completely around working within the child's realm of strength.

MR DOLMAN: Right. So both accessible and child centred really struck a chord with you.

MS SEEKAMP: Yes.

MR DOLMAN: Yeah terrific. Is there something in what Sarah said Ben that kind of draws you as well or other things?

MR ROGERS: Yeah. As an OT working closely with kids it became really clear early in my career that play was a primary occupation for kids, it's how they make sense of the world around them. And as a practitioner when I could step back and observe this with fresh eyes, you begin to see the child for who they are and their strengths, their values, their interests, you know even their vulnerabilities in that. So as Sarah mentioned, adding the parent into this and you know supporting the parent to be with those play experiences really does strengthen the parent-child relationship and the child's overall social and emotional wellbeing.

MR DOLMAN: Right. Yeah well I look forward to hearing what you've both got to say shortly. So yeah if everyone listening in participating in this webinar, if you could join me in really welcoming Sarah and Ben. So yeah I'll hand it over to you now Sarah.

MS SEEKAMP: Thanks Chris. All right, so it's unlikely to be new information to many of you that children who have a consistently responsive and nurturing relationship with their parent, typically go on to experience better mental health and are more resilient. And also experience better outcomes in school and later life. So for these children it's those nurturing and caring child-parent interactions that provide those necessary environments to optimise development and wellbeing for the children and then go on to equip those children to manage the negative effects of stress and adversity in life more effectively. So really for us we see that supporting parents to have a responsive relationship with their children is ultimately a powerful investment in child mental health. And perhaps before Ben and I get any further into the presentation we also just want to clarify that when we talk about parent throughout this presentation that we're really talking about any primary care giver. Okay so just I guess to really spell that out schematically. We just will be looking at how when we have a child engaging in child-led play and we bring a responsive parent into that play, the outcome can be a strengthened relationship and it's this relationship once it strengthens that enhances that mental health protective factor for the child and that's really what we're going to unpack for you today.

MR ROGERS: Yeah thanks Sarah. So this leads us to your role as a practitioner in relation to child-led play and as Chris mentioned, this webinar is aimed at practitioners who interact with families in universal services. So that's health, education and community services. So it's quite a broad range of practitioners out there so hello to everyone. . And we acknowledge that there's a high level of diversity and experience and understanding in this approach. Today we'll emphasise the importance of child-led play as a universal mental health promotion strategy. So it's an evidence informed approach that can be promoted by any practitioner. So the webinar today will be focusing on defining child-led play and its benefits. We'll look at how parents can participate in child-led play, we'll explore behaviour change theory and how this can support the way we work with families. And then the I guess the big part of this the first part is building awareness and knowledge for you as the practitioner. But we really want you to come away with some practical ways in which you can support parents in implementing child-led play. So in translating some of this knowledge into practice, we've developed two resources that you can use following the webinar. One of them is a practice resource for you to understand some background around child-led play and the other is a conversation guide which helps you starting those conversations with parents. So we'll go into that in more detail at the end of today's webinar and we've embedded some of the learnings from these resources into what we're talking about today.

MS SEEKAMP: Thanks Ben. So many of you will be familiar with the evidence based practice lens which represents our commitment and ambition to bring together the best research evidence in the field that we're working and what we've learnt from our clinical experience. And also then obviously filtering that with the clients values whom we're working with at the time. And today Ben and I will share with you some research regarding the benefits of child-led play and responsive child-parent relationships and we're going to draw on our clinical experience and share stores that reflect the value of some of the clients who we've worked with. But what we also really hope to do is provide opportunities for you to draw on your own expertise and reflect on some of the clients from your own experience and then contemplate how you might be able to apply some of the learning that we might present to you today. So we'll begin by ensuring we all have a shared and consistent understanding of what child-led play is as there's a broad range of terms that can be used to describe this concept. So what we're really talking about is play where the child is free to direct their own play where they are the decision maker moving at their own pace and discovering their own areas of interests and ultimately engaging in those things that reflect their passions. So further, I guess this play can look different depending on which child is engaging in the play because ultimately it will look differently depending on the age of the child, the child's developmental stage, their interests, values, cultural background. Even perhaps their sensory motor preferences from an OT perspective. And this play can absolutely involve playing with others so long as those key ingredients of child-led play aren't overly disrupted. So the child still needs to be able to feel that they are able to lead the play and make lots of decisions around what the activity looks like and the direction of the play as it moves forward. So shortly we will move into the parents' involvement in child-led play but what we really wanted to do was first acknowledge the vast array of benefits that child-led play provides for children in its own right. So children's freedom to express themselves through play is fundamental to their cognitive, physical, social and emotional development and wellbeing. This type of play allows them to explore the world in a world that they can master and as they begin go master those challenges they set themselves, they develop those new competencies and that leads to growth in their confidence and their resiliency and that better equips them to face challenges in their futures. And finally and perhaps most relevant to this presentation today, children whose parents regularly join their child's play are less likely to develop mental health difficulties such as anxiety, depression, aggression and sleep problems. So Ben is now going to have a bit of a closer look at how parents can participate in this play.

MR ROGERS: Yeah thanks Sarah. It's great to reflect on the benefits of child-led play and how children are innately driven to play and when they're given those opportunities to freely play it has a lot of benefits. What we are particularly interested in in terms of supporting the mental health of children, is using child-led play to strengthen the relationship between parent and child. So the question we ask ourselves is how do we introduce a responsive parent into this play. So child-led play is an ideal way for parents to engage with their kids. It requires the parent to tune into what their child's communicating, what are they thinking, what are they feeling, without distraction. And when parents observe or join their kids in this way, they're given this unique opportunity to start seeing the world through their eyes a little bit. The parents are encouraged to notice what are they thinking, what are they feeling, what are they doing, what do they want me to do. And we've talked about this term responsiveness. So the parents role is to be responsive in this way and when Sarah and I were talking about this, those qualities of love and delight are really a way of showing a child that they're responsive to them. Showing that they're interested in them, showing that they're validating their activities that they're engaging in. And these qualities of love and delight can look many different ways for parents, it can be smiling, it could be being curious, it could be noticing. It's that reciprocity between parent and child. I like the notion of encourage parents to be with the child in their play experiences, sending messages that I care or I hear or I understand. We really can't dismiss the primary drive that parents have to ensure that their children are safe. In order for child-led play to be effective for the parent, it's important that they're relaxed and fully engaged. So it's important the parent takes the time to create an environment which is safe and one where it's free for the child to explore without redirection. And I think that's really important, the idea of the parents' redirection. There's a few things for them to think about avoiding during this play. For instance not using child-led play as a reward, it's important the parent is fully focused on the play without interruptions or multitasking.

And that final point there I think is important and challenging for a lot of parents, is ways of them engaging without needing to teach or correct in any way. So when we're thinking about the benefits for the parent, parents often report that child-led play allows them to get to know their child as their own person. As we've mentioned a couple of times, you know a child with their own interests and values. They start to see their child from a different perspective, and one that's based on a better understanding of their strengths and overall vulnerabilities as well. So children and parents are in a constant flow of interaction and in this busy life that we're all living, parents can often miss or even misread some of those cues that are coming from a child to the parent. And this type of play gives the parent a deeper level of understanding of those needs. Parents begin to look under the surface, to look beyond the behaviour that they might be seeing and think about hey what's this child trying to communicate with me. I think this is an important perspective shift, it allows parents to start attuning to the child's needs more effectively. I'm sure you're starting to think about parents that this might be beneficial for and we'll talk about that a little bit later on. But it's really, it is useful to some parents where there is a narrative around some negative experience in their interactions with kids.

The next point there is also around it gives parents a focus, a sense of agency in being able to support their child's overall social and emotional wellbeing. Parents can often self-blame or feel guilty for not being available for their children. When putting this together I thought of an example of a mum that I worked with who had five children and her eldest son was referred to our service for mental health related difficulties. And this mum held a lot of guilt and shame in her words. She felt like she'd neglected the needs of her son. So child-led play was that perfect opportunity for her to take some action. For short periods each day she would follow his lead and give her full attention, her full love towards him. And it's this process that supported yes their connection but it also helped to minimise some of that negative self-talk that she had about herself. And finally those parents where there are levels of adversity happening in their life, child-led play can be a type of refuge for them, a time where they can anchor their attention fully in the present moment of their child's exploration. And there's a strong therapeutic process in this because opposed to focusing attention on the outside negative experience, they begin to step into their child's shoes and anchor their attention in a nonjudgmental way on their child's needs. And when Sarah and I were talking, we've often had parents say to us that that this was their favourite part of the day or week, a time that they set aside where they could truly see their child in a new positive light. And I think that word 'positive' is really important for us because child-led play opens that door for pleasant experiences, for joy, happiness and excitement. So let's just take a moment to stop and reflect on some of the learning so far. We've learnt that child-led play allows children to explore their environment freely without restriction. We learnt that play is a fundamental aspect to a child's cognitive physical and emotional wellbeing. And part of this process is having a responsive parent where they're full present, sharing in the love and delight of their child's experiences. And finally this idea of the parental perspective shift more towards the strengths and interests of the child overall.

MS SEEKAMP: Yeah thanks Ben. So we, as Ben alluded to, are now going to shift our focus a little bit towards practitioner strategies and tools that can enable our families who we're working with to take the next steps around child-led play. So I guess just to get you thinking, you know, who out of the people you're working with might this approach suit. And so Ben and I have put some suggestions down here and we've listed that parents and children who may benefit from strengthening their relationship, this would be an opportunity for them. Or definitely as Ben said before, perhaps it might be that you have a family and the child might be exhibiting some challenging behaviours and those behaviours become the dominant story in that family. And so this strategy provides an opportunity to lift up a different story around that child and to see some of the strengths and joy that the child can bring and participate in. Similarly, perhaps you might be working with parents who have incredible adversities in their own lives and therefore find it very difficult to put any priority on their child's needs and this can be a way that they can be enabled to do that. Or perhaps you might have families who as a whole are living through stressful times and like Ben said, I love that word 'refuge'. This might be able to provide a small regular window of refuge for the children and the parents that can help fill up their emotional cup to keep them moving through those stressful times. And then finally as this is a universal mental health promotion strategy, obviously we believe that this is actually something that will benefit everyone.

Okay so as we mentioned at the beginning of the presentation we'd really like to provide you the opportunity to think about how parental involvement in child-led play might fit into your practice, and so drawing on your knowledge and expertise as a practitioner and the values of your clients who you're familiar with and who you're working with on a day to day basis. So what we'd really like you to do is take a moment to think of a family who you're familiar with from your work and bring them to mind so that you can have them in mind as we move through the rest of the presentation. Okay, so we suspect that it's very likely that many of you are working with families who are living with multiple adversities and have quite complex lives. We believe that the iceberg model can sometimes be a helpful tool to make sense of this complexity. So I will just quickly introduce this to you. So above the water is what we see and measure. So that might be how well someone is or isn't, rates of childhood anxiety or perhaps a score on a mental health assessment. And then just below the water are the lifestyle behaviours that contribute to those measurable outcomes. Things like eating, drinking, sleeping, exercising, our interpersonal relationships, how we deal with stress and so on. And this is often the level at which our interventions target but sometimes that's without a good understanding of the factors that are at the very bottom of the iceberg, and this is the hardest part to see but the biggest part. And what's at the bottom of the iceberg is actually often what's led the person to be engaging in the very behaviours that we may be seeking to change and influence. And so trying to change those behaviours without understanding these other pressures that are driving those behaviours can be really hard work for both us and our clients.

I was reflecting also as I was putting this presentation together and was reminded recently of the importance of understanding what's at the bottom of the icebergs for one of my clients. A colleague and I were referred a little boy who's probably about 18 months I think, for support, as he hadn't been meeting a range of milestones. But in particular there were concerns around his social and emotional milestones. So this mum and her son attended most of our sessions across a ten week small group play based intervention but we just didn't see the progress for this little guy that we anticipated we might. And we were also really struggling to get a connection that we were happy with with either him or his mum. So we went back to have a bit further look at the context of the family rather than honing in on his development. And what we learnt at that time was that mum was living with mental illness and also that she had a violent partner who she was in the process of trying to leave. So these were really big factors at the bottom of the iceberg for this little guy and his mum. And certainly once we became aware of this, that gave us a much more appropriate understanding of his developmental presentation, and also some of the struggles that his mum was experiencing in terms of trying to develop her responsive parenting. And it's likely that it may have taken many of these weeks for this mum to feel able to share this information with us, but it does remind me well of the importance of continually seeking to understand a family's context so that I can be more attuned as I move forward in working with families.

So I just encourage you at the minute to take a moment to recall the family you brought to mind earlier in the presentation and just think about how much you know about what might be going on at the bottom of their iceberg and how this may influence their capacity to follow through on any of the recommendations that you might be making.

Okay we're just going to shift focus a little bit now. The other model that we would like to share with you today is around the stages of behaviour change presented by Prochaska. So as some of you might be aware, behaviour change theory can be really helpful to guide our practice when we're ultimately looking to change behaviour. So I'm just going to briefly talk you through this model now. So if someone was at the very bottom of this model in the precontemplation stage, they're really not considering changing anything. And so our role is about creating a curiosity as to how things could be different if some change may be possible, just to dip their thought into the water so to speak. And then they move into that contemplation stage, and people in this stage are starting to feel a sense of discontentment with their current situation but they're not really sure about what they need to do or what a goal might look like or where they want to be going. They're just knowing that something might need to be different. And so this is where our work can come in to help them create that vision and then move them into that preparation stage. And that preparation stage is really about narrowing down a focus on what they would like to be different and how they might get there and what might be some of the strengths and enablers that they could draw upon, and similarly being mindful of what might be some of the challenges and barriers to achieving their goal. And then naturally the action phase is about implementing that plan that you've worked together to develop and maintenance is about sustaining it. But I think it's also really important that we as practitioners are mindful, but also enlighten our clients that it is almost inevitable that always to some degree clients are going to relapse and we're going to need to return to those earlier stages to work with them again to get them back up to that action and maintenance phase. So the earlier stages of this model are really around building the client's motivation for action and the later stages are really around building their confidence and their sense of self efficacy in relation to achieving those changes.

MR ROGERS: So thanks Sarah. So again let's stop and reflect on some of the key learnings from that section. Sarah shared with us that child-led play is an approach that's beneficial for all families. We talked about the importance of understanding the factors that can impact behaviour change by looking at the iceberg and what's underneath the surface. And then we explored what's important in terms of understanding the stage of readiness for change, looking at a behaviour change theory. And then you've started to translate some of this learning into reflecting on clients that you're currently working with at the moment.

MR DOLMAN: We've actually had a question from someone who has been reflecting on people they work with at the moment and they have a question about grandparents and I know you, when you both spoke earlier, you took a broad view of the definition of a parent. The question relates, you know, do you think that grandparents have a role to play given that they aren't the primary caregiver. And perhaps sometimes can more readily enter into play with a child because of the stresses and demands on parents. Is that something that you've come across in your practice and yeah, your thoughts around that?

MS SEEKAMP: Yeah, actually that's a really opportune question for us to lift that up Christ thank you. Because I guess what the research tells us is that children just need someone, they just need one consistent responsive person in their life. And sometimes unfortunately that can't be their parent for whatever reason. And so if there is an available grandparent, and there's many grandparents out there who desperately want to help, then this is - and an accessible way for them to do that, then they are a very appropriate person to pursue that with, yeah.

MR DOLMAN: I guess why stop at grandparents really, I guess there might be other people in the broader family that have particular caregiving responsibilities at particular times for the child.

MS SEEKAMP: Absolutely.

MR DOLMAN: Or neighbours, other people that are close to the family yeah.

MS SEEKAMP: Yeah.

MR DOLMAN: So you're advocating for that as well, yeah, great.

MS SEEKAMP: Yeah I think so. I think one of the challenges as we look broader is we still need to do and Ben is about to launch into some talking about building knowledge - - -

MR DOLMAN: Okay.

MS SEEKAMP: - - - so people are really mindful about what child-led play looks like because that's the key ingredient, the child needs to be the leader of the play. But really the more people in a child's life that are able to engage in child-led play with them just further validates the child's joy in the activities that are meaningful to them. And that you know instantly fills up their emotional cup.

MR DOLMAN: Great thank you. Yes there are some other questions but we'll leave those to later perhaps, so yeah, thank you for that.

MR ROGERS: So yeah thanks Chris and Sarah. This – this kind of final section of our presentation today is looking at really practical ways that you as the practitioner can promote child-led play with families. So we'll look at you know how do you connect with families and strengthen their capacity, looking at making a plan and then the idea of action and reflection as part of that process. So the first step in this process and in many processes that we take when a family comes into our service, is about connecting with them. So it's really important that the family members feel safe and supported, so they can openly express their feelings, their fears, their hopes. And I know firsthand that this can be difficult for practitioners when we're limited by time. But it's important for us to stop and reflect that this is the most important step for us initially with a family and we often do come back to this at different stages as well. And so just as we described following the child's lead in play, connecting is an opportunity for you as the practitioner to meet the parent where they are right in this moment. And it's, you know I think the first stage really acknowledges that every family has a unique history and circumstances. What Sarah touched on a bit earlier around context is really important here. And the way we work with family really needs to reflect their context overall. So an understanding of the family's cultural, social relational context is key to helping integrate this approach into their daily lives as a family. So how do we go about doing this, you know what is this connection and how does it look. I'm sure you're already kind of reflecting on the ways that you build connection with families but some of those qualities are listening, remaining curious, working collaboratively in a partnership with a family. And it's by doing this that we build that understanding of previous experiences and we start to understand the strengths and vulnerabilities of the families. And so let's take an opportunity now for you to reflect on the way that you connect with families. How do you go about understanding their context and what core qualities do you draw on to support this process.

So this next section is about strengthening capacity for child-led play for that parent and with behaviour change, in the early stages our role is about building the client's motivation for action. Building knowledge can really provide the drive for this motivation. And we know that parents are highly unlikely to do what we tell them just because we say so, especially when it comes to changing behaviour. And I think back to myself earlier in my career, I remember you know doing that, connecting with families, doing my assessment and giving that feedback and recommendations at the end of that process. And in there often I would put a recommendation about child-led play without discussing it with the family and when they returned to the service I would talk about the things that were going well. But often parents would say, 'Oh sorry I didn't have time for that' or 'I forgot to do that strategy, sorry about that'. And this is a really key example of how I was missing the opportunity to build knowledge for that family. Because the reality is that many parents, you know they may not have heard of child-led play before as an approach, so the first step following connecting with the family is to build that knowledge. What is child-led play? Talk to them about the role of the child, their role in child-led play and talk about the benefits of child-led play with them.

That next point there is around drawing on their knowledge of previous play experiences and I wouldn't mind us splitting this into two ways of looking at this. I think the first way is that parents come with their own level of insight already around play and we really want to draw on their strengths in this. So meeting them in the conversation, meeting where they are right now around this. They might say you know reflect on a previous experience where they had a lot of joy in playing with their child. So they're opportunities to really tag and build on that knowledge. The other part of this is looking for those times perhaps when things aren't going as well, that can provide the bridge into almost tagging some meaningful information about child-led play. You know a parent might reflect on how their child doesn't want to play with them anymore or they're not feeling as connected with their child. And as a practitioner we can name that and say, 'It sounds like you really want to spend more time connecting with your child, there's this thing called child-led play which might be supportive for you'. So by tagging that it makes it a little bit more meaningful for that parent in the context of their life. And overall it's just about providing information for that parent so they can make the decision about whether they use this or not.

And this next section is around strengthening the capacity for child-led play. It says knowledge there but this is really about confidence. For some parents this may be the first time that they're contemplating this approach and it can be vastly different from how they were brought up or even how they've ever acted. And I think you know, our role as a practitioner is really important here because a parent can be feeling quite vulnerable with this. So we need to ask ourselves what does the parent need support with. It might be around emotional support, whether that's listening or providing empathy, you know it's quite important for us to normalise a parent's unfamiliarity with child-led play, talking about and also acknowledging that many parents can feel unsure about how to play with their children. And within that there's some practical things that we can support families with as well in building their confidence. Some parents find it useful to label or comment on their child's play, that really helps them to stay engaged in the process because it can be difficult for sustaining attention for extended periods of time for some parents. And also you know how do we prepare the environment as well and providing information to support them with that. Really what we're doing is looking at focusing on building the strengths of the parent and as a practitioner what that means is we need to at times model these skills for parents. And what that means is that we also need to feel vulnerable with that. So what does that involve? It involves us getting on the floor, it involves us taking off our practitioner hats and it involves us following that child's lead in play. And I've got an example here when I was putting this slide together. I was working closely with a dad who I was introducing child-led play with. And the dad was in that contemplation stage. Now we'd built the connection, we'd built some knowledge and he's really interested in finding ways of strengthening his relationship with his son at home. And in the discussion he said, 'Look Ben, I wouldn't mind if you'd just show me a little bit about how to do this, you know it's different to the way I've engaged with him before'. So we're in the room and I'm following the child's lead and the dad is next to me and the son you know crawls through a Lycra tunnel across the room. And for those that don't know what a Lycra tunnel is, I don't know Sarah, do you have any way of describing what a Lycra tunnel is?

MS SEEKAMP: I think well you could probably liken it to going down the leg of an oversized pair of leggings perhaps.

MR ROGERS: That's a very good way of describing it. So you know the boy's gone through and here's me at the end and I'm like all right I've got to do this. So I'm crawling through all the way to the other side. And the boy was smiling when I got to the other side but he looked over at his dad and he's like come on dad, what are you doing. And so the dad you know crawled across, went through the tunnel and I'm smiling thinking about this because really when that dad got to the end, the laughter, the joy that they shared is what it was all about, that connection. And although you know I was modelling that for the dad to build his confidence, it was actually the child that built his confidence in the end. So that's an example of how we need to be vulnerable in this space and at times children can build the confidence of their parents as well.

MR DOLMAN: I was just wondering, there was a question that came through just before you began speaking about that point actually, you know a question about in circumstances where the parent has fairly limited or no experience of play themselves because of the circumstances around which they grew up in I guess. And just about how to respond to that, and so you've mentioned kind of modelling that play as a key response to that kind of circumstance. I'm just wondering yeah, were there other things around that that can also sort of yeah support those parents that perhaps can't draw so readily on their own experience?

MR ROGERS: Yeah I think a really important thing is the steps that we've touched on here.

MR DOLMAN: Yes.

MR ROGERS: You know it sounds like for some parents really for them the confidence is a big piece. And we can reflect on the information I just shared. In some of that I think really building on the strengths of the parents can be a good example of that. And even just breaking down the idea of what it is, you know demystifying what child-led play is because although it is you know unfamiliar to a lot of parents, what it involves is them just sharing and delighting in their child's play experiences, which they would've done in other circumstances. And you can always relate to that through their own experiences.

MR DOLMAN: Right.

MR ROGERS: You know, when you – and it could be anything. An example of watching them play football and when you're cheering or when they're eating or you know in the bath time. Whatever it is, building on the strengths and where they can relate to that as well. Yeah hopefully that kind of answers that question.

MR DOLMAN: Sure, yeah, no thank you.

MR ROGERS: You know an important question so thanks for that.

MS SEEKAMP: Okay, and I think probably I'm about to get to something which might help that listener as well Chris - - -

MR DOLMAN: Okay great.

MS SEEKAMP: - - - to see how we can scaffold some of the plans up and down a little bit. All right so Ben has just given us a lovely insight into how we can build the family's knowledge and capacity relating to child-led play. And so hopefully in an ideal world after we've spent some time in that space with families they'll be ready to move into that preparation stage and so our role then becomes about creating a vision for change and a plan for that. So as I've just alluded to, this phase is really about becoming very clear about what the parents is hoping to achieve and then working with them to find out what are the steps to get them there. And having the parent articulate what they want to achieve and what they hope might be the outcomes if they're able to achieve that goal is really important because it allows the families to identify what feels manageable for them. So similarly to what that listener was just talking about as well. For some families their capacity is small so the goal needs to be small, it needs to be realistic and achievable for them so we need to scale that right back initially and then we can grow it in time as their skills and confidence grow. And then as they also set this goal then it conveys to us and to them, you know what are they intending to do and what are the motivations for their actions. And that information can be really powerful for us as a practitioner to be aware of because as perhaps a parent's motivation towards finding the time and energy to engage in this process with their child might wane on and off, then we can lift up to them and remind them you know what is it that really made them want to engage in is in the beginning.

So with that family with the five children you know that mum was feeling shame and guilt around not being able to show her love to her oldest child. And so that sort of insight is really powerful for us to help support that person to maintain their motivation moving forward. I think the other thing that we as practitioners really need to be mindful of is sitting with parents as they refine their goal takes time and is usually quite hard work. And I think certainly myself as a practitioner I can often see what I think would be a really nice fitting goal for someone and I really almost have to bite my tongue to hold onto that so that the parent can get there themselves and come to their own goal and their own plan. And certainly the literature really clearly tells us that when we do allow the parent time to come up with this goal themselves then the likelihood of them actually committing to this and achieving it is actually significantly higher. So our role really becomes one of facilitator, someone who can share information as Ben was saying, and ask questions that can help positon the client to be able to work towards identifying their own goal. So for example it might be if a parent is trying to work out how much time they're going to spend with their child in this goal, it might be that we might clarify for them well five minutes in pure play time with your child three times a week is actually a much stronger investment in your child's mental health than one hour every week or so because that predictability and that consistency is what really will make a difference for that child. So then the parent can go on and go okay so I don't have to make this a really big long thing, what I've got to do is make sure that I feel like I can actually stick to this regularly. And similarly perhaps finding the right time and space.

So for our chaotic families I think that can be one of the biggest challenges where they can actually look into their already busy lives and think my goodness, where am I going to fit one more thing. And certainly that mum who I talked about earlier with the little boy who was about 18 months old, you know her life, and his life was really tough. And when we were looking for a window to strengthen their relationship and invest in his mental health, what we ended up finding was bath time. She was regularly bathing him most days of the week and she would stay present to ensure he was safe. And so what we did is we just scaffolded that time up a little bit by she would offer him some toys in the bath and then sit close to him and then look for that shared attention and give him a warm face with a smile. And then we had it such that she was just aiming to you know notice and name some of the things he was doing and demonstrating her delight and validation in him that way.

So I've just included a couple of other examples which kind of also relate back to that other listener which will show you how you can kind of start small or bigger depending on where your parent might be at. So the first one there is this week I'll play with Joe on two days after school for 15 minutes. So you know that's probably a middle of the road type of goal for someone to try and achieve. And then the next one, three times a week when Isaac plays outside, I'll ask if he'd like me to play with him and follow his lead if he wants me to join in and then play for at least 15 minutes. So you can see in that middle goal the parents really has to have a more sophisticated understanding of what following Isaac's lead is going to look like because that's going to be what's going to determine the success of that goal. And then lastly scaled right down again, a little bit like the bath goal, we had a parent who regularly just plops the child on the floor and floor time is important, but we were looking to lift the connection. And so what we moved towards is when I put Emily on the floor I'll provide her with a range of toys and the mum was going to sit with her for five minutes. Just five minutes before she moved off, and in that time she was going to notice which toys Emily sought out and seemed to enjoy. And try just describing, 'Oh you're banging the block', what are some of the things that Emily might have been doing with some of those toys.

MR DOLMAN: Actually Sarah, I think those goals again link to a question we've had from a listener around as mental health practitioners, how do you advise a parent who's had a long day at work, come home feeling quite exhausted from that of course. How do we advise them to be involved in child-led play, to enter into that or not. It's a very real circumstance of families I guess.

MS SEEKAMP: It is and as a parent Chris, I think that once I had kids I had a way better insight into what we're asking of families.

MR DOLMAN: Okay.

MS SEEKAMP: And you know my life is not a chaotic life by many standards.

MR DOLMAN: Right.

MS SEEKAMP: So I think it's really important that we're mindful of that and hence the importance of spending that time working with the parent for them to set the goal and for you to kind of amplify that what we're looking for is consistency. It doesn't have to be a huge chunk, you know five minutes regularly is a place to start. And I think the other really big thing which probably relates to Ben and I having an OT background, you know looking at the occupations that that family are already engaging in, like bath time, meal time, you know driving in the car to school.

MR DOLMAN: Okay.

MS SEEKAMP: What opportunities are there in some of the things that they're already doing just tweak a little bit and then doing it that way.

MR DOLMAN: Thank you.

MS SEEKAMP: Okay. So once the parent's created that vision, however small that might be as a starting point, what we really need to do is then have a look at what are the steps that are going to increase the likelihood of them being able to sustain this change and achieve their goal. And for some families this conversation might be quite brief and informal because they might have reasonable capacity to problem solve and make plans and their lifestyle might be quite routine. But I suspect for many of the families who we're all working with, this process is almost vital to ensuring that the family can move from wanting to achieve their goal and actually being able to achieve their goal. So this provides a really great opportunity to build the parent's capacity in planning and problem solving and for the parent to become much more mindful of their own supports and barriers as they move forward. So what I've done here is I've just lifted out of our practice paper that Ben alluded to a little bit earlier some of the prompting questions that can support this process. So some of the things that you might want to unpack with the client as you're working through the plan is what things might get in the way of this playtime happening. And so what might the parents see could be done to overcome some of those challenges. Or perhaps as we alluded to before, you know what's going to keep me motivated. Like life is tough and full as that last listener's question kind of really lifts up for us. So how am I going to stay motivated towards achieving this goal that I've set around shared playtime. Or also for some families and most of us I think, if we're trying to embed a new routine into our lives, just remembering to do something that is new and that we're wanting to do regularly can sometimes be a barrier. So actually unpacking well how am I going to remember to do this if I've scheduled to do it after school two days a week, how am I going to remember. You know is it a note on the fridge, is it a reminder on my phone, what does that family member, that parent think might work for them. And then finally what are some of the things or the people, what are the strengths and resources available to help make this plan possible. They might be physical things like a backyard or toys or a local playground or they might be a supportive partner or parent that we can draw upon.

Okay so we're nearly at the end. So finally we've got the action and reflection stages. So as I alluded to really the action stage is obviously about the client implementing their plan. But as a practitioner there's a few things that we can do that makes all the difference to the likelihood of success for the client. So making it clear to the client that we're interested and we're with them and want to see how they're going to go with achieving this goal is a really important thing to demonstrate. And we can most usually demonstrate this by either a follow up appointment or a phone call, and ideally we don't want this to be more than two weeks past setting the goal because we want to try and get them on the right track early. And this follow up has two really key purposes. On the one hand it enables you to continue to collaborate with the client in working towards maintaining their goal that they've set towards and conveying your genuine interest in how they go with that. But secondly, and importantly, it sets up an accountability in relation to their goal. And what the research really tells us is that if some – if people know that someone is going to follow up with them and see how they went with something, they're way more likely to actually follow through on that action. So again is another strategy to really lift the likelihood of success for your client. And finally this follow up provides the practitioner with the opportunity to facilitate reflection by the parent and unsurprisingly this is a really important part of the process. It provides the opportunity for the practitioner to enable the client to unpack how they went with working towards their goal and look at what went well and even if we have to find the smallest things there, it's really important to be able to lift up some progress and some success. But also importantly we can lift up what didn't go so well and validate the challenges that got in the way of the parent's success this time. But then return to some of those preparation stage type conversations around acknowledging that as a barrier and then trying to problem solve around that so you can move past that in the future. So this process can be really important for parents with lower self-efficacy because it can be presented as an acknowledgement that things don't go right all the time and in fact when we're trying something new it often might not go right. But if we as practitioners can lift up what did go well and then support the client to problem solve around those things that didn't go well, then again we're able to build the capacity of the parent to self-reflect and persist in moving forward. So finally just take a minute to think about that family you brought to mind earlier and I wonder what sort of opportunities there might be for this type of accountability and follow up to provide some support for your clients to achieve some of the goals they're working towards.

MR ROGERS: Thanks Sarah. So we've got four key messages for you to take from today and I think there's lots more you can take but really reflecting on child-led play as an important health promotion strategy for all families. And we focused on the strengthening of the parent-child relationship in child-led play, and we touched on behaviour change theory and how this can be helpful in enabling families to act on implementing this strategy. And then we talked about practitioner needs around supporting and tailoring this to the family's context. Now one of those things following a webinar is that you've got all this information, what do I do with it now, that's been really great, but where to go next. And these two resources really can help guide you in that process. You've got one resource which is a practitioner specific resource and one that's a conversation guide which can help you with having conversations. So they're linked into our website but also embedded into some of the webinar material that you currently have.

MR DOLMAN: Great, thank you Sarah and Ben for that. And thank you to those that have – many people actually that have been submitting questions around a variety of things. We have got a little bit of time to address some of those. There has been some questions around adolescent play but I think we'll hold those for the forum to respond to those given they're a fraction outside of the scope of what we're talking about today. But there's been a number of other questions to around that theme of practitioners who don't have – sorry parents who don't have the capacity, capacity or are time poor. And so I know you've mentioned a number of things particularly again towards the end of the presentation Sarah in response to that, but are there other things you'd like to say in terms of what your recommendations might be for practitioners who are working with parents who just don't have that kind of capacity for this type of approach with a child?

MS SEEKAMP: Look I think there's probably two – there's a key decision a practitioner has to kind of make when they're faced with that challenge.

MR DOLMAN: Okay.

MS SEEKAMP: They have to kind of look at does this parent have some capacity and you know where it might be literally five minutes in a small window, or does this parent have no capacity. And so the answer to that question will then turn the practitioner either to you know talking with that parent about acknowledging the adversities they're facing at the minute but also lifting up their child's needs and saying something that would be really important for the child is a responsive person spending some time in play can be a way that can be fostered are there other people who could perhaps you know play this role for your child and look to identify those people and then perhaps follow this process with them and see how they might go. Or otherwise as Ben said, you know, we need to spend that time scaffolding that skill and knowledge development but then setting a very small achievable goal to start with.

MR DOLMAN: And are there – is there a particular age range you have in mind of children when you're speaking or are we looking you know up to 12 years of age broadly or?

MS SEEKAMP: I - even it was interesting with that question in relation to adolescents. I think all children, well and the research will tell us all children will benefit from having that responsive consistent person in their life. And when you follow the child's lead, what you're doing is just going to look different depending on the age of that child. So what you do with the adolescent, you know, is going to be different because it's going to be what their interests are versus what you do with an 18 month old child. But I think that you know ultimately we can apply this type of model right across the age spectrum.

MR DOLMAN: Great. And there's been some questions too about fathers as well which I know have been very present in our conversation as we've spoken. But are there sort of – what are some ways, because I know you gave an example Ben of working with a father, but what are some ways that you've both found around the best ways of supporting fathers as you do this work?

MR ROGERS: Yeah so when supporting dads, I guess thinking of when that dad comes into the room, you know what's been their exposure to the process of getting there. And often if a parent is – a dad is in the room that's a really good sign, that's the first starting place to be able to work with them. And the focus is on a lot of the things we've already talked about, it's about building trust and connection. But what I find with dads is that they really do love this practical approach to getting on the floor with their kids and once you've built that trust, when you've listened to their experiences. And I find using the same language that the dad uses with me really helps them to connect with the overall approach. I know obviously being a male at paediatric OT I worked a lot with dads, but I think that really does go for any practitioner working with dads is building that trust and connection over time as well and using language. And I think reflecting on how the service really shapes the way that a dad comes into that room, what's their perspective when they step in the doors, is it one of collaboration and partnership. Because that's really what we want to foster here. Yeah, so and you know we spoke about grandparents, even siblings I've worked with are really engaged in child-led play as well. Any support network really is beneficial for the child.

MR DOLMAN: Great. I know you've mentioned as part of your presentation that one of the things that could get in the way of parents participating in child-led play is actually quite a fixed and diminished view of their child, you know a negative view of their child. And there's been a question around that in terms of okay so, and you would notice this as you're speaking to the child. How do you respond to that, you know with a view to sort of inviting them into child-led play.

MR ROGERS: Yeah we both kind of went to go on that one.

MS SEEKAMP: Yeah.

MR ROGERS: But do you want to go first?

MS SEEKAMP: Yeah sure. I think one of the things as I'm listening to the question that seems to be coming to mind by Chris is I'm wondering whether the child is present or not.

MR DOLMAN: Okay.

MS SEEKAMP: Because I think there's a strategy I learnt from a colleague that works particularly well if the child is present because what you sometimes see is parents talking about this horror story of this child that's doing this, that and the other, and we've tried this and nothing is working rah, rah, rah, while the child is there which is really unideal for that child. And so the strategy of bringing that child straight into that conversation as a way of you demonstrating their presence. So oh my goodness, you know say the little boy is called Tim, say, 'Gee Tim that sounds like you've had a really hard time and you've tried lots of different things and you're still feeling like things aren't going very well, that must be incredibly challenging for you'. And it's a

MR DOLMAN: Bring their voice in, yeah.

MS SEEKAMP: Yeah bring their voice in, and then I think that you then can begin that very obvious collaboration with the parent and the child right from the beginning then. And you can talk about one of the things that can be really helpful in this situation when times have been really tough, is for us to find some time doing something that actually brings us joy and closer together outside of those challenges that'll still be here and need to be addressed but this can give you both a break from those really tough times and then you introduce it as a strategy. Ben do you have something you want to add?

MR ROGERS: Yeah I think you covered a lot there Sarah and I think for me working with families, I get really curious with the parent often and say, 'Has this always been the case?' or 'Can we just go back to a time where you can remember spending that time connecting in play'. And I was thinking of a scenario when you were just talking then of a parent that I worked with who we'd built up to the point where she was actually engaging in
child-led play with her daughter and had those you know quite fixed views, you know every time we talked with the child not present she would talk in negative ways about that child. But then in the session I noticed that she was sharing and delighting, she was smiling, and you know in that moment as a practitioner it's really important we can draw the parent into that and say, 'I can notice there's some emotion here, it looks like you're feeling is it happiness' or just drawing that in. For that parent when I did that it was kind of a felt experience, which in a way can help to shift how they view their child overall. And I know there's many ways you can go about this but as Sarah reflected, the fundamental is connecting with the parent, understanding their own experiences and when we start to do that we can really work with the families really effectively.

MR DOLMAN: What if – and again another question, about the – and gosh we haven't got much time so it might have to be a fairly shorter answer we'll answer more fully perhaps on the forum. But what about you know sometimes, you know children that perhaps become aggressive during this playtime and you know some of the dilemmas that brings I guess parents, and practitioners I guess as you hear about it.

MR ROGERS: You go yep.

MS SEEKAMP: Okay I guess I'm wondering whether they're envisaging that this is occurring in a clinic setting where you might have been practising some play or this is a parent reporting back from home.

MR DOLMAN: Right, not sure.

MS SEEKAMP: But I think I'd really want to understand you know like we do any time we try to manage challenging behaviour is what went on before. Because if a child is just happily engaging in what we described earlier in the presentation as that free child-led play, they don't typically get too aggressive unless perhaps they became frustrated with something that didn't go quite right. But what you do often see aggression coming in is if someone comes in and intrudes on that play in a way that then makes them feel judged or non-validated or a failure. So I'd be really interested to learn about well what went on before that happened and what might have been some of those (indistinct).

MR ROGERS: Yes and what the parent's response is I guess to that as well. Just very quickly

MR DOLMAN: Sure.

MR ROGERS: I'd reflect on what it is they're observing. You know is it the child hitting the teddy with a hammer and that's perceived as an adult as aggression. So we really need to look at this with fresh eyes.

MR DOLMAN: Okay.

MR ROGERS: And I think when we do that as a parent we can see things a little bit more differently to whether it is actually aggression or is it this child making sense of something. I think that's an important thing we can take out of this as well.

MR DOLMAN: There's lots more questions, there's lots to explore and thank you again for those that have submitted them, we will be responding to them in the forum. Thank you so much Sarah, thank you Ben for your contributions today, yeah thank you to all the participants out there. Thanks to the folks at CFCA behind the scenes for making this webinar happen as well. And so yeah, please follow the link on your screen to the website and continue this conversation. Thanks very much everyone.

WEBINAR CONCLUDED

IMPORTANT INFORMATION - PLEASE READ

The transcript is provided for information purposes only and is provided on the basis that all persons accessing the transcript undertake responsibility for assessing the relevance and accuracy of its content. Before using the material contained in the transcript, the permission of the relevant presenter should be obtained.

 

The Commonwealth of Australia, represented by the Australian Institute of Family Studies (AIFS), is not responsible for, and makes no representations in relation to, the accuracy of this transcript. AIFS does not accept any liability to any person for the content (or the use of such content) included in the transcript. The transcript may include or summarise views, standards or recommendations of third parties. The inclusion of such material is not an endorsement by AIFS of that material; nor does it indicate a commitment by AIFS to any particular course of action.

This webinar was held on Wednesday 4 December 2019.

Please post your comments and questions below.

Child-led play is an approach to playtime that relies on the parent following the child’s choices, leads and prompts without teaching or correcting. It helps parents to focus on the individual needs and preferences of their child and contributes to developing children’s skills in creativity, problem solving and decision making, increasing their confidence and resilience.

In this webinar, Sarah detailed how practitioners who work with families with children aged 0–12 years can adapt child-led play to their specific professional circumstances and use it as a mental health promotion strategy. This webinar assists practitioners who interact with families in universal health, education and community services, including early childhood education and care settings, through:

  • describing how practitioners can play an important role in promoting child-led play as a mental health promotion strategy for all children
  • outlining how practitioners can support parents to use play with their child to gain insights into their parent–child relationship, and their child’s strengths and vulnerabilities
  • exploring play as a mechanism to begin conversations about the hopes that parents have for their relationships with their children and increasing parents’ agency to make positive change
  • providing strategies that develop the resilience of children and have positive effects on their long-term social and emotional wellbeing.

Related resources

  • Parent-child play: A mental health promotion strategy for all children
    This practice paper provides practical information on the use of play to strengthen child-parent relationships and promote children’s mental health. 
  • Parent-child play: Conversation guide
    This resource compliments the practice paper and is for use with families who are interested in working on their playtime. It is intended to be filled in by parents but provides an opportunity for the child and practitioner involved to talk about the benefits of play in a family.
  • Parent-child play: Practice resource
    You may like to use this Practice resource in conjunction with the Conversation guide. It has two components: a conversation guide that practitioners can work through with families, and practitioner notes that provide support for introducing parent-child play and using the conversation guide.

This webinar was co-produced by CFCA and Emerging Minds in a series focusing on children’s mental health. They are working together as part of the Emerging Minds: National Workforce Centre for Child Mental Health, which is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.

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Featured image: © GettyImages/monkeybusinessimages

About the presenters

Sarah Seekamp

Sarah is an Occupational Therapist who has spent much of her career working with children and families in primary health care settings. This work has involved partnering with children, parents, carers and educators to build their capacity to support children’s physical and emotional development.

In her work Sarah seeks to acknowledge the complexity of parenting while exploring the child’s experience of the world as a way of understanding their presentation. Much of her work is focused on play and supporting parents to play with their children in ways that encourage positive growth in the child.

Sarah currently lectures in the Occupational Therapy Program at the University of South Australia.

Ben Rogers

Ben is a Paediatric Occupational Therapist working with the National Workforce Centre for Child Mental Health. Ben's professional experience has seen him work in a variety of mental health and child and family services within Australia and the United Kingdom.

Over the past few years, Ben has been working for Royal Far West, an organisation that supports rural and remote families with complex needs. During this time, Ben worked within a complex developmental assessment service and provided telehealth therapy and capacity building to children, parents and teachers.

As a practitioner, Ben draws on his interest in sensory processing, attachment, play and mindfulness-based interventions when supporting children and their families.

Questions and comments

I often find parents are much more comfortable engaging in directive play with their child and I use this to engage families in supported playgroups, do you have any tips on how I can structure the playgroup to involve more child led play in a group setting?
Sarah
It may be helpful to begin by providing the parents with some brief and simple info on what is child-led play and its benefits, then perhaps scaffold the experience and set aside no more than 10 minutes initially in a group for the parents to practice following their child’s lead. This will of course look different for different age groups; providing open ended play experiences / toys for the children will support this. It would be great to close these 10 minutes with a reflection about what the parent noticed about their child and how they found the experience. Maybe in time you could regularly allocate a portion of your group to parents following their child’s lead.
Sarah and Ben
I'm working in an adolescent mental health service, how might child led play be used for parents struggling to connect with adolescent children?
Louise
The principles remain the same, including that the parent needs to try to demonstrate their interest in their child’s interests – with older children this could be asking about an activity the teen enjoys. As with younger children, if there are opportunities to join with their child in an activity the child enjoys this will also be a great opportunity to grow the connection. One of the challenges in this context with teens will be that the parent and child may have very different interests and for the parent to set their values and interests aside and make this only about exploring and understanding their child’s interests could be very tricky. The focus of the interaction needs to remain only on the activity and the child’s vision for the activity. Hence again starting with education about child-led play and the parent role in this and its benefits will be important.
Sarah and Ben
How do we know we are striking the balance between adult-led and child-initiated activities to meet best the children’s outcomes?
Jackie
It depends on the goal of your work together. If it is to build parent capacity to connect with their child, then the emphasis needs to be on child-led interactions. However, if alongside that you are also seeking to provide play experiences to support child development – e.g. motor, sensory or communication then there will be a balance and I think the role of the practitioner then is to ensure the parent understands the two different approaches and that they are both incorporated into goal setting.
Sarah and Ben
We are considering updating the toys available in our treatment rooms. Are there any specific types or toys you recommend to encourage child led play in a clinical setting?
Jessica
Depending on the age…. options that allow open ended play can be helpful i.e. blocks, Lego, paper and crayons, animals and props for imaginative games.
Sarah and Ben
When working with a child that has a developmental delay such as autism do you need to adjust this approach?
Kayla
This approach with children who have autism is more complex, however there is absolutely a place for it. It is likely that children on the spectrum will not tolerate our ‘intrusion’ on their play for as long as typically developing children, so the parent needs to watch for the child’s cues regarding this. So often for these children we are trying to bring them into our world, however the parent can spend some time with their child in the activities they enjoy. It may include mirroring the child’s actions, using affect and expression or the child may indicate to the parent what they want them to do and the parent can follow this lead. However as with the earlier question- it is also important to couple this with play that is designed to developmentally extend the child – i.e. the goal of the 2 approaches are different.
Sarah and Ben
How do you identify a good time for child led play and should you stop the play if the child become upset/ overwhelmed?"
Kayla
A good time is when there is some free uninterrupted time. However, for young children, when they are not too tired is also helpful. Sometimes it can work well if the parent seeks to join the play that the child is already involved in and so this can be a more flexible approach.
Sarah and Ben
How do you address this strategy where people from different culture do not consider play as important? Where play is looked at as a waste of time compared to reading and learning?
Wendy
I have worked with a number of families from cultures who value more formal learning approaches over play. As mentioned in the webinar, spend time connecting with these families, learn about their perception of play, develop understanding of their knowledge in this area, and discuss the benefits of child-led play. Using this understanding can support sharing of evidence-informed information, which can guide motivation and confidence in this area. I found talking with them in lay terms about the neuroscience and research so they can grow their perspective is sometimes helpful.
Sarah and Ben
What would be your recommendations as a minimum time limit for child-led play per week?
Camille
Rather than thinking in terms of the minimum time, explore with the family what might be possible given their circumstances, and start with that. For families that are really going to struggle to fit it in – try embedding it in an already occurring activity i.e. like the bedtime routine or bath time if possible.
Sarah and Ben
When the child only wants to play on electronics, what do you suggest as a response for the parent?
Robyn
Join the child on the electronics – this is about following their lead. Encouraging them to participate in other activities can happen at another time. Child led play is about the parent following the child interests, not trying to change their interests.
Sarah and Ben
What's the age range that this type of play is suitable for?
Melinda
There are benefits of embedding this early for children, particularly in the first 3 years of life due to the rapid brain development, however children of all ages will benefit from having a responsive relationship with at least one adult and this approach can be drawn upon to support this throughout this period.
Sarah and Ben
How does a practitioner end a child-led play experience?
Megan
If the child has a concept of time, be upfront about your time available at the beginning and then 100% focussed for this period of time. Otherwise acknowledging the play experience they have had and create anticipation of playing together again. For some children it can be beneficial to prompt them around what is happening following their play experience, eg: going in the car with parent etc.
Sarah and Ben

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