Best Practices in Play Assessment and Intervention

33
OVERVIEW
Best Practices in Play Assessment
and Intervention
Play is enjoyable and motivating for children, and it is
how they spend much of their time. Not only is play an
important part of children’s daily routine, it is also a
window into their developmental levels and a context
where valuable teaching and learning can occur. Play as
an assessment/intervention context is relatively new in
the field of school psychology but is increasingly popular
with practitioners and researchers because of the current
emphasis on ecologically valid assessments, contextbased
interventions, and progress monitoring. Play
assessment and intervention meets the response-tointervention
(RTI) component of the 2004 reauthorization
of the Individuals with Disabilities Act. In fact, the
National Association of School Psychologists’ (NASP)
Position Statement on Early Childhood Assessment
specifically states that play assessment is an appropriate
approach to evaluating the needs of young children
(NASP, 2005). The additional and powerful benefit of
play assessment is that it also leads directly to
interventions and progress monitoring in the same play
context. Finally, play assessment has been suggested to
be a culturally sensitive practice (Meisels & Atkins-
Burnett, 2000).
Play is ubiquitous in early childhood. Young children
are constantly at play. Play can be conceptualized as an
activity that is not a means to an end but an end itself
(i.e., play for the sake of play), is motivating to the
individual, and is associated with positive emotions
(Tamis-LeMonda, Uzgiris, & Bornstein, 2002). Play
assessment is when play is used as the context for
evaluating a child’s current level of functioning and
determining whether there are areas that require
Lisa Kelly-Vance
Brigette Oliver Ryalls
University of Nebraska at Omaha
intervention. Play intervention is when these interventions
are conducted in the play context.
For the purposes of this chapter, our focus will be on
assessment and intervention in the cognitive domain.
While play assessment and intervention can be used in
other domains such as communication, motor, and
social, it is beyond the scope and purpose of this chapter
to include them.
Important to the understanding of how play assessment
and intervention came to the attention of school
psychologists is the interest that basic researchers have
had in the topic for decades, resulting in a vast empirical
foundation (e.g., Piaget, 1962) that can be applied to the
identification of children with specific intervention
needs. Piaget’s extensive study of how children’s play
changes with development is one of the earliest and
arguably the most influential examples of such research.
Specially, he chronicled the change from sensorimotor to
representational play. Numerous descriptions of the typical
developmental progression from exploratory to pretend
play have been well documented and empirically
supported (e.g., Belsky & Most, 1981; Elder &
Pederson, 1978; Fenson, 1984; Fenson & Ramsay,
1980; Lyytinen, 1991; McCune-Nicolich, 1981; Tamis-
LeMonda & Bornstein, 1996). While the specific
terminology varies, what is described is a consistent
and predictable progression from simple exploratory
behaviors such as mouthing to complicated episodes of
pretend play.
BASIC CONSIDERATIONS
The use of standardized tests with young children has
been criticized on several fronts. These types of tests
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Best Practices in School Psychology V
serve eligibility purposes but do not provide information
about how to develop or monitor appropriate interventions,
they are not ecologically valid and do not assess
the child in the natural context, and they are a
potentially unmotivating and inappropriate means of
gathering valid information about a young child (Kelly-
Vance & Ryalls, 2005). Further, many practitioners
have expressed misgivings about the use of tests to
determine young children’s current level of performance
(Barnett, Macmann, & Carey, 1992) and would prefer to
use alternative strategies such as play assessment
(Bagnato & Neisworth, 1994).
The origins of play assessment and intervention
stem from psychoanalytic work with children at the
turn of the twentieth century. Therapists used information
from children’s play to determine their mental
health needs and then used the play context during
therapy. This practice continues in many different
therapeutic approaches. More recently and for the
reasons discussed above, school psychologists working in
early childhood began using play assessment as an
observational strategy in the 1980s (as discussed in
Athanasiou, 2007). Linder (1990) brought even more
attention to the procedures with the publication of
her play assessment model and her subsequent play
intervention model (Linder, 1993a, 1993b). Practitioners
have been using play assessment and intervention, but
the empirical support for its use has only recently
emerged (e.g., Cherney, Kelly-Vance, Gill-Glover,
Ruane, & Ryalls, 2003; Farmer-Dougan & Kaszuba,
1999; Kelly-Vance, Needelman, Troia, & Ryalls, 1999;
Kelly-Vance & Ryalls, 2005; Kelly-Vance, Ryalls, &
Gill-Glover, 2002; Myers, McBride, & Peterson, 1996).
Fortunately, studies are confirming what practitioners
have known intuitively, which is that this approach is a
reliable and valid means of assessing young children (see
below). Moreover, the assessment procedures can be
used regularly to monitor the progress of children
receiving interventions.
Training and Equipment
While the specific materials and procedures required for
different versions of play assessment and intervention
vary, all forms are similar enough that general guidelines
concerning equipment and training can be provided.
With regard to equipment, one of the advantages of play
assessment and intervention is that no specialized
materials, forms, or equipment are required. All types
of play assessment and intervention involve children
playing with toys or other play materials (e.g., crayons
and paper). While some forms of play assessment do
require a particular set of play objects (e.g., Fewell as
cited in Athanasiou, 2007), others can be conducted in
any toy room or early childhood classroom (e.g., Kelly-
Vance & Ryalls, 2005; Linder, 1993a; Ryalls et al.,
2000) as long as the available toys are diverse enough to
elicit a wide range of play behaviors, including complex
pretend play, and are attractive to both boys and girls.
Some specific considerations regarding toy choice will
be discussed below.
Although no specialized equipment is necessary to
conduct play assessments or interventions, some training
and experience is necessary; however, the nature of this
training depends on the RTI tier in question. Certainly,
knowledge about child development in general, and the
developmental course of play in particular, is necessary
at all three RTI tier levels. A thorough understanding of
a tiered RTI system and the specific problem-solving
approach used with children who have more intense
needs is necessary in utilizing play assessment to guide
the intervention process. With regard to the informal
assessments that occur at Tier 1, the school psychologist
needs to make sure the personnel and parents involved
have a general understanding of how and when play
changes with development. At Tier 2 or 3, most forms of
play assessment can be considered observational coding
systems, and thus some experience using such systems is
beneficial. Familiarity with the specific coding system is
obviously required, as is some training and experience
identifying particular examples of success or failure or
assigning specific codes to play behaviors (e.g., substitution).
As with any observational coding system, such
experience is necessary to ensure the reliability of the
assessment across observers and across play sessions
(Salvia, Ysseldyke, & Bolt, 2007). The nature and
amount of training depends on the particular form of
play assessment involved. With respect to the type of
training required for actual intervention implementation,
all interventions are grounded in the context of
play and thus require no specialized education or
training above and beyond the specific interventions
themselves.
BEST PRACTICES
Types of Play Assessment
Unlike other forms of early childhood assessment,
relatively little activity has occurred in the development
of play assessment techniques. Of those that exist, only
three have been described in enough detail to use in
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practice. These three approaches are described in the
following section.
Play Assessment Scale
The Play Assessment Scale (PAS) is designed to evaluate
the developing skills of children from 2 to 36 months
(Fewell as cited in Athanasiou, 2007). This 45-item scale
is developmentally sequenced and is organized into eight
age ranges and toy sets so that only a portion of the
items are rated for each child. Children are first
observed in spontaneous play followed by a facilitated
play session, and their play behaviors are coded
according to the scale so that a play age can be
determined. The play age is composed only of those
behaviors observed in spontaneous play. A basal/ceiling
approach is used and a conversion chart allows the rater
to convert the raw score to the child’s play age. Anyone
familiar with the PAS can administer the items and
complete the rating scale, but Fewell stresses that the
individual rating the child must thoroughly understand
the individual PAS items and the play behaviors that
would justify that a child possesses the skill reflected in
each item.
Transdisciplinary Play-Based Assessment
The most thoroughly described play assessment technique,
Transdisciplinary Play-Based Assessment
(TPBA), was developed by Linder (1990, 1993a). Her
transdisciplinary approach captures the essence of
collaboration in that early childhood service providers
and parents work together to find out information about
a child’s developmental levels and link it directly to
interventions. The team approach is conducted in what
she called an ‘‘arena’’ format where individuals from
various disciplines observe the child in free play and
document the play behaviors. The adults communicate
their findings with one another throughout the observational
period allowing for a shared perspective on the
child’s skill level.
General guidelines for conducting the data gathering
sessions were published in her ground-breaking book
(Linder, 1990). Prior to the play session, the professionals
contact the child’s caregiver to find out their
concerns and preliminary information on the child’s
functioning. The structure of the session takes into
account any information obtained from the parents.
The observational team consists of a play facilitator who
engages with the child, a parent facilitator who is
responsible for discussing the process with the parent(s),
Play Assessment and Intervention
the evaluators, and a person to operate the video
camera. A large play area such as a classroom is
recommended for the session, but any setting with a
variety of toys can be used. Initially, the child
plays alone and no structure is imposed upon the
activities. The play facilitator can participate but not
initiate any of the play. Facilitation occurs in the
second phase where the adult attempts to engage
the child in activities that have not yet been observed
and may be in the child’s repertoire. It is essentially a
testing phase. Following the two phases involving
adults, the child is then observed playing with
another child and then interacting with a parent. A
phase of motor play then occurs adhering to the
same sequence as the initial play activities. The session
ends with a snack, and feedback is provided to the
parent(s). The entire session lasts between 60 and 90
minutes.
Unique to the Linder model are the detailed coding
guidelines. She provides developmental coding schemes
for cognitive, social–emotional, communication and
language, and sensorimotor development. The applicable
ages vary, but, in general, the coding guidelines
apply to young children up to 60–72 months of age.
Each general category of development (e.g., cognition,
communication, motor skills) is subdivided into more
specific categories labeled subdomains. These coding
guidelines are used to describe a child’s strengths and
their area of intervention need. Specific suggestions for
intervention are derived from the assessment results
(Linder, 1993b).
Play in Early Childhood Evaluation System
The Play in Early Childhood Evaluation System
(PIECES) is the most recently developed and extensively
investigated approach to play assessment (Cherney et
al., 2003; Kelly-Vance, Gill, Ruane, Cherney, & Ryalls,
1999; Kelly-Vance, Needleman, et al., 1999; Kelly-
Vance & Ryalls, 2005; Kelly-Vance et al., 2002; Ryalls
et al., 2000). The PIECES grew out of empirical work
originally based on Linder’s TPBA cognitive development
assessment guidelines. The PIECES approach is
both similar to and dissimilar from Linder’s TPBA
approach. With regard to assessment procedures, like
TBPA, the PIECES assessment involves observation of a
child engaged in free play. The PIECES is also similar to
Linder’s TPBA in that the assessment can be conducted
in any setting with any toy set as long as the toy set is
large and varied enough to elicit a wide range of
behaviors.
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Best Practices in School Psychology V
In the PIECES assessment, children play freely for
30–45 minutes and can be videoed. They are not
required to produce any specific behaviors with any
specific toys. The procedures are dissimilar from
Linder’s TPBA in that the child usually plays alone
and without any facilitation on the part of adult
observers. Parents and a session facilitator are present
and free to praise the child and to repeat what the child
says, but are instructed not to ask questions or suggest
new play behaviors. Because the PIECES focuses
exclusively on cognitive development, a multidisciplinary
team of observers, while certainly allowable, is not
necessary.
With regard to the coding guidelines, Linder’s TPBA
and the PIECES are similar in that the guidelines are
broken down into multiple scales examining different
domains of cognitive development, although the specific
domains differ. The PIECES coding scheme contains
one core subdomain (exploratory/pretend play) as well
as several supplemental subdomains (see Table 1). The
supplemental subdomains (e.g., problem-solving skills
and planning, categorization, quantitative skills) are
adapted versions of several of Linder’s subscales.
The PIECES coding guidelines differ from TPBA in
that the 13-item sequence that makes up the exploratory/pretend
play core subdomain was drawn not from
Linder but instead from the extensive empirical
literature on the development of play (Belsky & Most,
1981; Fenson, 1984, Lyytinen, 1991; Tamis-LeMonda,
Bornstein, Cyphers, Toda, & Ogino, 1992). In the
PIECES coding system, every play behavior produced
by the child can be classified on the core subdomain
whereas the supplemental subdomains are reserved for
specific types of behaviors (such as trial-and-error
problem solving, sorting, and drawing), which may or
may not occur in any given play session. The
information obtained from this coding procedure is
then compared to norms for typically developing
children to determine if the child has specific areas that
require intervention. Interventions are targeted at the
core and/or supplemental subdomain skills found to be
discrepant from peers.
Research on Play Assessment
Emerging evidence for the validity of various forms of
play assessment has been reported in several studies.
Support for the validity of PAS was established by Eisert
and Lamorey (1996), Fewell and Rich (1987), and Finn
and Fewell (1994). In these studies, PAS was found to
correlate with standardized and nonstandardized measures
of cognition, communication, motor skills, and
adaptive behavior. Two published studies have reported
on the validity of Linder’s TPBA model. The Myers et
al. (1996) study of social validity found that parents and
early childhood professionals preferred TPBA model to
more traditional information yielded from standardized
tests. Kelly-Vance, Needelman, et al. (1999) found a
high correlation between scores from the Bayley Scales
of Infant Development II and the cognitive development
guidelines from Linder’s TPBA. In addition, one
unpublished dissertation examined the concurrent and
content validity and the test–retest and interrater
reliability of TPBA and found it adequate (Friedli as
cited in Athanasiou, 2007). A study of a more general
form of play assessment found adequate validity when
comparing a brief play assessment scale to measures of
development (Farmer-Dougan & Kaszuba, 1999).
Thus, while there is a smattering of publications
on play assessment measures, much more work needs
to be conducted to meet the current standards of
reliability and validity, particularly in light of the
fact that such techniques are explicitly listed as an
alternative assessment method in the NASP Position
Statement on Early Childhood Assessment (NASP,
2005).
Table 1. Core Subdomain and Supplemental Subdomains Assessed in PIECES
Subdomain Levels Description
Core
. Exploratory/pretend play 13 Ranges from mouthing and simple manipulation to extended sequences of pretense
Supplemental
. Problem-solving skills and planning 12 Ranges from simple search for a hidden object to complex means-end problem solving
. Categorization skills 19 Ranges from simple combinations based on perceptual similarity to complex
classification based on nonperceptual features
. Quantitative skills 10 Ranges from counting 1–5 to recognizing and labeling all numbers 0–9
. Drawing skills 21 Ranges from scribbling to drawing and/or copying complex forms and shapes
. Seriation abilities 11 Ranges from understanding of basic dimension terms (e.g., big) to seriation of four
or more objects
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This lack of research motivated us to begin a
systematic examination of the psychometric properties
of play assessment. We began with the development of
coding guidelines. Our goals in the development of these
guidelines were to develop a system of assessment that
would thoroughly evaluate a child’s skills in the cognitive
domain, would lead directly to the development of
appropriate interventions to be implemented in the
context of play, and would easily allow for monitoring
the effectiveness of these interventions.
As discussed above, we began with the most popular
form of play assessment, Linder’s TPBA, and adapted
her coding guidelines to include information drawn
from extensive basic research on play. The resulting
PIECES guidelines have been evaluated empirically and
found to have high interrater reliability (Kelly-Vance &
Ryalls, 2005). In addition, this high interrater reliability
was achieved with a relatively simple training procedure.
That is, individuals with a background in observational
techniques can be trained to accurately and reliably use
these guidelines to assess play behavior with as little as a
half day of training (Kelly-Vance, Gill, et al., 1999;
Kelly-Vance et al., 2000).
In addition to work developing psychometrically
sound coding guidelines, we have also worked to
develop a play assessment procedure that is both
practical, from the perspective of practitioners and
families, as well as valid and reliable. Our procedure,
again initially based on Linder’s technique, was briefly
described above. In developing this procedure, we have
empirically examined a number of session characteristics
and identified a process that is effective as well as easily
and accurately reproduced. We have investigated
numerous procedural aspects including toy selection
(Cherney et al., 2003), facilitation versus nonfacilitation
(King, McCaslin, Kelly-Vance, & Ryalls, 2003), the
familiarity of the context (Drobny, 2003), and the
impact of the presence of a peer (Fredenberg, 2004;
Mendez, 2005). We have also examined other important
attributes such as test–retest reliability (Kelly-Vance &
Ryalls, 2005), correlations with other standardized
measures (Fiscus, 2006), and use with special populations
(Gill-Glover, McCaslin, Kelly-Vance, & Ryalls,
2001; Johnson, 2005; Kelly-Vance, Needelman, et al.,
1999).
How to Conduct a Play Assessment
Because the PIECES is the only approach that has been
empirically tested to this degree, we believe it to be best
practice at this time. We have focused on developing a
procedure that is both valid and reliable and is
practitioner friendly. While we believe this method to
be best practice, the model allows for flexibility in
ensuring that the procedures are appropriate for each
individual child. The basic structure described below
should be used, but adaptations for specific referral
concerns should be taken into account.
Session Characteristics
Play Assessment and Intervention
Context
One of the many positive characteristics of play
assessment is that it can be conducted in a variety of
settings such as home, daycare, preschool, or laboratory.
We have consistent results when play assessments
conducted in the home were compared to those in a
laboratory setting (Drobny, 2003); however, the child’s
comfort level should be considered when selecting the
location and interpreting the findings.
Selection and Organization of Toys
When selecting toys for play assessment it is important
to make sure that the toys are appropriate for the age,
assumed developmental level, and gender of the child
being assessed. While it is commonly recognized that
children of different ages/developmental levels may
choose to play with different types of toys, it is important
to keep in mind that boys and girls also have preferences
and these preferences may have an impact on the
outcome of the assessment. By 2 years of age, children
display preferences for certain types of toys (O’Brien &
Huston, 1985). That is, boys and girls tend to prefer to
play with toys that are stereotypically consistent with
their own gender. While both boys and girls show this
tendency, research has shown that this tendency is more
pronounced for boys (Cherney et al., 2003). Specifically,
Cherney and colleagues found that while boys played
with predominantly male stereotyped toys (e.g., cars and
trucks), girls played predominantly with neutral toys
(e.g., puzzles and cash register). More importantly, for
both boys and girls, it was found that the male
stereotyped toys elicited the simplest forms of play and
the female stereotyped toys (e.g., dolls and kitchen set)
elicited the highest levels of play. Thus, when conducting
a play assessment the school psychologist should
ensure that a variety of toys that are gender appropriate
are available and encourage children to play with toys
that have the potential to elicit more complex forms of
play.
In addition to the types of toys present, the
arrangement of the toys must also be considered. For
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Best Practices in School Psychology V
the purposes of play assessment, it is important that all
toys are visible and accessible to the child. In addition,
similar toys (e.g., dolls and doll-related toys) should be
grouped together to encourage thematic play. Finally,
while the playroom should be neatly organized, it need
not be pristine, and, in fact, a mild level of disarray may
be helpful to encourage certain types of behaviors.
Specifically, problem-solving behavior is often observed
when children attempt to assemble puzzles and
construct train tracks, so leaving them somewhat
unassembled is recommended.
Facilitated Versus Nonfacilitated Play
Some play assessment approaches involve significant
levels of facilitation and/or modeling, often requiring
the reproduction of very specific play behaviors. We
believe, however, best practice involves a nonfacilitated,
free-play situation with minimal direction. Our rationale
is twofold. First, eliminating facilitation from the format
helps ensure a more standardized session, which
removes facilitator bias and increases the likelihood of
obtaining high levels of reliability across raters, children,
and sessions. Second, there is empirical evidence that
facilitation either has no effect or, conversely, has a
negative impact and children’s ratings are actually lower
after adult direction (King, et al., 2003). One exception
to this guideline concerns questions about skills that may
not have been demonstrated during the session or
potentially emerging skills. It is appropriate to attempt to
elicit behaviors described in certain supplemental
subdomains, such as drawing and/or counting, that do
not spontaneously occur for many children. Similarly, if
there are questions about the upper limits of some
emerging behaviors it is acceptable to attempt to elicit
such behaviors, particularly when developing interventions.
Instead of facilitating play in a traditional sense,
parents and play team members may participate in
child-directed play and verbal praise. In addition, adults
should redirect children (e.g., ‘‘What else can you play
with?’’) who continue to play with the same toy in the
same manner for 5 minutes or longer. This is an attempt
to vary the play behaviors during the session but not to
encourage any specific type of play.
Presence of Peers
Another form of social interaction involves the presence
of a peer in the play assessment process. This approach
is appropriate for evaluating social interactions but may
have limited utility when determining cognitive functioning.
Mendez (2005) and Fredenberg (2004) analyzed
the impact that same-age peers had on a child’s
cognitive functioning and found that it did not improve
the level of play. In fact, evidence suggests that different
characteristics in peers elicit different types of play.
Given that our goal is to standardize play assessment
procedures, it would follow that peer interactions are not
a necessary component of the session.
Describing Children’s Play
Children’s cognitive levels can be described by using
the PIECES coding guidelines. Practitioners should
familiarize themselves with the guidelines and use it to
analyze a child’s skills and areas that may need
intervention. The play behaviors are documented by
videotape (or live play if videotape is not available).
Specific examples of play should be noted as they apply
to the core and supplemental subdomains. Then the
behaviors are compared to the coding guidelines and the
child’s highest level of play is noted for all subdomains.
In addition, practitioners may also want to document
the type of play that was seen most frequently in each
subdomain. Finally, the child’s age equivalents from the
PIECES subdomains are compared to his or her
chronological age and discrepancies are noted.
Best Practice in the Use of Play Assessment
Data in an RTI Model
Given the requirement of systematic, data-based
practice of RTI, play assessment and intervention is a
logical choice for school psychologists working in early
childhood settings. Play assessment and intervention
have several features that make it appealing in an RTI
model of practice. The developmental sequence
described in play assessment coding schemes allows
practitioners to monitor progress in a logical and
empirically validated manner, and data can be collected
regularly and with minimal environmental modification.
Play assessment is one piece of data that can be
collected and integrated with other assessment
approaches to gain a complete picture of the child’s
level of performance.
In contrast to standardized tests that can be difficult
for parents to comprehend and find useful, the
information obtained from a play assessment is easy
for parents to understand. Providing interventions in the
play context is also a logical format, and early childhood
teachers and parents of young children are arguably
more likely to demonstrate treatment adherence if they
find the process credible.
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RTI’s conceptual three-tiered model can be applied
to play assessment and intervention (see Table 2). The
first tier parallels general education in the school-aged
population. In early childhood, this tier applies best to
families, child care centers, parent resource facilities,
and community agencies. School district personnel and
educational service units can disseminate general
information about child development, how to observe
children’s play to determine where they are functioning,
how to promote cognitive development through appropriate
play activities, and who to contact if a child is not
meeting developmental milestones. The goal at this tier
is for families and early childhood caretakers to have
access to the information and implement simple, basic
procedures of play assessment and intervention.
Research indicates that mothers have a basic understanding
of the order of play development but know less
about specific developmental milestones in play than
milestones in other domains such as language and motor
development (Tamis-LeMonda, Chen, & Bornstein,
1998; Tamis-LeMonda, Shannon, & Spellmann,
2002). If a parent or childcare worker has concerns
about a child’s development, contact can be made to the
school district or educational service unit, and Tier 2
interventions will be considered.
In Tier 2, a formal play assessment is conducted by a
school psychologist, and the child’s strengths and areas
of intervention need are determined. Based on this play
assessment data, interventions are then developed
collaboratively with the professional who conducted
the play assessment and the individual(s) responsible for
intervention implementation. Possible intervention providers
include parents, preschool teachers, and child
care providers. Given their knowledge of data-based
decision-making and intervention development, school
psychologists are an obvious choice for the role of
consultant with these cases. This role includes interpreting
assessment data, scripting the intervention, and
monitoring the progress of the intervention. If a child is
in a preschool or daycare center, small group interventions
may be appropriate and the consultant could
develop a protocol for several children with similar
needs. Otherwise, individual interventions may be
required. Incidentally, the frequent use of individual
intervention at this level contrasts what generally occurs
with school-aged children where small group interventions
are most common at Tier 2. In both individual and
small group interventions, a goal is determined and the
child’s progress is regularly monitored by the service
provider. At this tier, progress is determined by using the
play assessment coding scheme and periodically evaluating
the child’s rate of progress toward a goal. Because
of potential for rapid change in early childhood,
frequent monitoring is recommended.
Tier 3 is a more intense version of Tier 2 and may
require that a child spend a trial placement in an early
intervention program. The intervention is more
intensely implemented, progress monitoring data are
collected more frequently, and a team of early childhood
professionals should be included to consider whether the
child is eligible for special education services. At both
Tiers 2 and 3, a play assessment coding scheme provides
a benchmark for where a child should be functioning
and can help teams evaluate a child’s discrepancy from
peers, rate of progress, and amount of support needed to
ensure progress. If the child continues to be functioning
significantly below his or her peer and is not progressing
at a rate that would indicate he or she may catch up,
early intervention services through special education
should be considered and a full evaluation conducted.
The child’s response to the play intervention should be a
major consideration in the eligibility decision.
Case Illustrations
Table 2. Play Assessment and Intervention in a Three-Tiered RTI Model
Play Assessment and Intervention
As can be gleaned from the information above, play
assessment and intervention can be effectively used in an
RTI model at all three tiers. In this section we will present
two case examples to illustrate more specifically how this
process would unfold. The first case will exemplify the first
tier and describe how information about play can help a
parent better understand his or her child’s development
and determine whether the child is progressing appropriately.
The second case will address the second and third
Approach and intervention Tier 1 Tier 2 Tier 3
Assessment approach Screening Monthly or bimonthly Intense frequency (weekly or more)
Intervention approach General skills Small groups Small group or individual
Service delivery approach Informational Consultation and/or direct services Consultation and intensive direct services
Intervention agents Parents Parents, teachers, childcare providers Parents, teachers, childcare providers, and
special education support staff
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Best Practices in School Psychology V
tiers by describing how play assessment and intervention
can be used in early intervention services.
Case 1
Ms. Austen, a mother of three young children, contacted
Springfield Elementary School to find out more about
child development and, more specifically, whether her
children were on the appropriate developmental
trajectory. Ms. Austen then met with the school
psychologist who served Springfield Elementary. She
stated that her main concern was whether she was
providing the appropriate learning environment for her
children to develop necessary skills and be ready for
kindergarten. The school psychologist suggested that, by
watching her children play, Ms. Austen could learn
about how her children were functioning. She was asked
to keep a record of the type of play that her children
frequently engaged in as well as any newly emerging
play activities. One month later, she returned to the
school to share her observations with the school
psychologist. The PIECES coding scheme was discussed
with Ms. Austin and compared to her observations (see
Table 3), at which time it was determined that the
children were functioning within the normal range. This
reassured her that she was providing appropriate
activities. The session concluded with the school
psychologist giving Ms. Austen a handout that listed
developmentally appropriate activities that she could do
at home with the children.
Case 2
Ms. Jennings visited the pediatrician for her 3-yearold
son Jeremy’s annual examination. During the
appointment the pediatrician interviewed Ms.
Jennings, who had concerns that her child might not
be demonstrating age-appropriate cognitive skills. The
pediatrician gave Ms. Jennings pamphlets on typical
developmental milestones for 3-year-olds and referred
her to the school district for screening. Ms. Jennings
contacted the school, and the early childhood consultant
went to the house to conduct a screening of Jeremy.
This screening consisted of an observation of Jeremy
during 30 minutes of free play followed by an interview
with Ms. Jennings. The early childhood consultant
determined that Jeremy’s pretend play was below the
expected level and the consultant referred him to the
early childhood school psychologist. The school psychologist
conducted a more thorough play assessment of
Jeremy in his preschool and then classified his behaviors
using the PIECES coding scheme. In total, the play
behaviors observed in the preschool were consistent with
both how Ms. Jennings reported that Jeremy plays at
home and what the early childhood
practitioner reported seeing in the initial play
assessment.
In the exploratory/pretend play subdomain, Jeremy’s
skills were predominantly at the level of simple single
behavior pretend play acts. An example of this type of
play was when Jeremy pretended to eat a cookie and
then had his teacher pretend to eat the cookie. Active
other-directed acts were emerging but less common,
indicating skills at the 24-month level. Jeremy demonstrated
this skill when he was playing with a toy dog and
made it bark. In contrast, age-appropriate pretend play
at Jeremy’s age should have involved short sequences of
three pretend play acts such as making the dog bark,
Table 3. Examples of Ms. Austen’s Descriptions of Her Children’s Play and Corresponding PIECES
Codes
Children Mother’s description PIECES subdomain and level
Brady
(4 months)
Elliot
(28 months)
Lydia
(51 months)
. Plays with feet and chews on toes . Exploratory/pretend play: mouthing
. Bats at toys . Exploratory/pretend play: simple manipulation
. Grabs toys/anything and puts them in his mouth . Exploratory/pretend play: mouthing
. Makes snakes with Play-Doh; slithers them around
and says ‘‘sssss’’
. Exploratory/pretend play: active other-directed act
. Counts to 14 . Quantification skills: counts to 5+
. Pretends to be a cat; crawls around and meows . Exploratory/pretend play: self-directed act
. Puts on sunglasses, grabs a bag, and says, ‘‘Bye Mommy,
I go work.’’
. Exploratory/pretend play: multischeme combination
. Lines up toy cars by size . Categorization: sorts objects by size
. Makes pretend cookies with Play-Doh; offers cookies
to guests
. Exploratory/pretend play: multischeme combination
. Draws birthday cake, adds candles, sings birthday song . Exploratory/pretend play: multischeme combination
. Plays doctor: gives shots, looks in throat and ears,
gives medicine, listens to heartbeat, performs surgery
. Exploratory/pretend play: event
556 Chapter 33, Volume 2

feeding the dog, and then petting the dog. Jeremy’s
baseline for this type of pretend play was zero. The goal
was that, after 6 weeks of intervention, Jeremy would
demonstrate three-step nonfacilitated pretend play acts
in a half-hour play session.
With regard to the supplemental subdomains, Jeremy
was observed to be functioning somewhat below the
expected level on categorization skills. Specifically,
Jeremy showed some deficiencies in sorting and nesting
objects. The school psychologist followed up on this
observation and found that prompting play with nesting
cups and a nested puzzle did not improve Jeremy’s
performance. The goal established based on assessment
was that, after 6 weeks of intervention, Jeremy would
spontaneously or with facilitation successfully nest a fiveitem
series of nesting cups and complete a nested puzzle
depicting common shapes (e.g., circle, square, and
triangle). Jeremy’s performance on the other supplemental
subdomains (problem-solving skills and planning,
quantification, drawing, and seriation) was at ageappropriate
levels indicating no need for intervention.
Intervention for both target areas involved modeling
and adding to Jeremy’s spontaneous play behaviors. For
example, if Jeremy pretended to feed a toy dog a cookie,
the interventionist would add to Jeremy’s behavior by
modeling an additional play act, such as pretending to
pour the dog some milk. In addition to modeling, direct
teaching of sorting and nesting behaviors was also used
to increase age-appropriate categorization behaviors.
Both the preschool teacher and the mother were
trained to implement the interventions. Training for
the teacher and mother was conducted by the school
psychologist in one 30-minute session. The school
psychologist was in contact with the teacher and mother
on a weekly basis to address concerns and monitor
intervention integrity.
To monitor progress the school psychologist observed
Jeremy in a free-play situation once a week. At the end
of 6 weeks of intervention the data were reviewed and it
was determined that Jeremy had met the goal in the
core subdomain of pretend play (see Figure 1) but not in
the supplemental subdomain of categorization (see
Table 4). Thus, in this case play assessment and
intervention led to improvement in one of two target
domains. While the goal was not met in the second
subdomain, both the parent and teacher believed that
Jeremy had shown improvement over the course of the
intervention and chose to continue implementing the
interventions. Because of the progress shown, it was
determined that no referral for early childhood special
education services was necessary.
Figure 1. Case 2: Pretend play progress
monitoring data.
Number of Pretend Play Acts
4
3
2
1
0
Baseline Week 1 Week 2 Week 3 Week 4 Week 5 Week 6
Weeks
SUMMARY
Goal Line Trend Line
The existing empirical literature indicates that there are
numerous benefits to using play assessment and intervention
with young children. Because the assessment is
conducted in the natural environment of play, it is motivating
and elicits the highest level of a child’s functioning.
The process offers flexibility while remaining
Table 4. Case 2: Categorization Progress Monitoring
Data
Week Spontaneous (S) or
facilitated (F) play
Play Assessment and Intervention
Play behavior with nesting cups
and shape puzzle
1 F Nested two cups
F Placed circle in puzzle
2 F Nested three cups
F Placed circle in puzzle
3 F Nested four cups
S Placed circle in puzzle
F Placed square in puzzle
4 F Nested five cups
S Placed circle in puzzle
F Placed square in puzzle
5 S Nested two cups
S Placed circle and square in puzzle
6 S Nested three cups
S Placed circle and square in puzzle
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Best Practices in School Psychology V
psychometrically sound. The results of a play assessment
lead naturally to interventions that can be
implemented and monitored by many different individuals
in various settings with a minimal amount of
training. As exemplified in the case studies, this method
can be used by parents and educators in an RTI
framework.
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