Taking play seriously! New practice guideline about play and occupational therapy
Every child has a right to play freely and in their own way. A child who can play has hope – to grow, to develop, to heal and connect with others. Yet play is rarely prioritised as a therapy goal, meaning many young people – particularly those with a learning or developmental disability - lack the support they need to take part in this important childhood occupation.
Occupational therapy and play>span class="normaltextrun">’ (RCOT 2023) helps us think differently about play. It recognises that enabling play participation is a valued therapy goal and makes evidence-based recommendations about how we can use play in our assessments and interventions in a meaningful way. The recommendations direct us to pay attention to play as an internal state of being and not just as an observable state of doing.
The guideline objective was ‘to describe the high-quality, contemporary evidence on the occupation of play and the use of play in occupational therapy assessment, intervention and as an outcome of therapy to inform occupational therapy practice for those working with 0–18 year olds in the UK’.
The guideline development process
The guideline was developed using the National Institute of Health and Care Excellence accredited processes defined within the RCOT Practice Guideline Development Manual (4th ed) (RCOT 2020). The guideline development group included RCOT members, public contributors, a play therapist and a Royal College of Paediatric and Children’s Health representative. Additional input was sought from occupational therapists, members of the public, young people and other stakeholders throughout the development process.
The guideline development group and other reviewers screened and appraised relevant literature, grading the quality of evidence using a standardised approach. Evidence was synthesised to develop recommendations for play as a therapy goal or outcome, as an assessment and as an occupational therapy intervention.
Nothing about us, without us
Underpinning our approach to guideline development was the belief that young people should be involved in processes that are about them. We asked young people to tell us what makes play fun for them, and why they think playing is important. This ensured the essence of play is embedded throughout the guidelines. Towards the end of the development process, we worked with an inspiring group of young performers who brought the guidelines to life through a piece of interpretive theatre. You can watch their performance here: https://youtu.be/kkzOBVpi5RI
Recommendations
Fourteen recommendations are organised under the following three headings:
· Play as a goal and outcome of occupational therapy
· Play as an assessment
· Play as an intervention.
There is also one best practice suggestion where the evidence supporting it is still emerging. You can find the details of the recommendations in the guideline.
Implications for practice
This new practice guideline provides occupational therapists with an evidence-based rationale for prioritising play participation alongside self-care and school-based goals for children and young people. Using the guideline will ensure the play-based assessments and interventions we use are evidence-based, with outcomes measured as changes in play participation rather than how often or ‘well’ a young person plays.
The full practice guideline together with evidence tables, implementation resources and the audit tool can be found on the RCOT website.
An open access editorial on the guideline in the British Journal of Occupational Therapy can be found here.
References
Royal College of Occupational Therapists (2023) Occupational therapy and play practice guideline. London: RCOT. Available here.
Royal College of Occupational Therapists (2020) Practice guideline development manual - 4th edition. London: RCOT. Available at here.
Ward G, Payne S (2023) Time to take play seriously: The Royal College of Occupational Therapists’ Occupational Therapy and Play practice guideline. British Journal of Occupational Therapy. Available here.