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Professional Opinion

Play-based Interventions

The Primary Mental Health Project offers early detection and prevention of social-emotional problems for children in K3.

I have been a school social worker in the small Westmoreland Central School District in central New York for 26 years. And I have experienced what is now documented in research, that schools are seeing more children with mental health difficulties, such as fear and anxiety. These problems occur for various reasons, including family and tempermental issues, and often emerge at an early age.

Mental health services for children are frequently provided by schools, especially when families are unable or unwilling to engage with often limited resources in their own communities. Therefore, if educators do not address the social-emotional health of their students, the difficulties will likely continue or increase, and school success and even completion may be jeopardized.

There are various early detection and intervention mental health programs available for schools, as identified in the “Promising Practices Network,” a special online listing of recommended mental health programs (see resources), including “Child FIRST” and the “School Transitional Environmental Program.”
However, in our district, we have had significant and continuing results through the Primary Mental Health Project (PMHP), an early intervention, prevention, and detection program which involves the act of play for K3 students. Rocco Migliori, superintendent at Westmoreland, supports using PMHP for young students who show early signs of school adjustment difficulties. “This is an opportunity to intervene in a child’s life as early as possible and make deep contacts with a child’s home much sooner,” he says.

Research Roots

PMHP began in a Rochester, N.Y., school 55 years ago, and is now used by more than 1,000 schools nationally and internationally. Its roots are in the clinical psychology program at the University of Rochester, and it is a program of the Children’s Institute, a nonprofit agency dedicated to offering innovative research-grounded programs for children.

The project starts by screening all K3 children, as teachers complete the Teacher Child Rating Scale (TCRS) online. This assessment quantifies social-emotional adjustment in four school-related areas: task orientation (academic behavior), behavior control, assertiveness, and peer social skills. We augment these data with supporting observations from teachers, parents, and our building principal, and identify those children who may benefit from 12 to 14 sessions with a paraprofessional trained in child-led play. The students lead their own play time, and under my supervision, the paraprofessional interprets what the play means. Progress is checked by re-administering the TCRS when the sessions are completed.

Play Dates

The children have a 30-minute “play date” once a week with “Miss Bunny,” our paraprofessional. “In here, you can choose to play in most any way you want!” are the first words a young child hears upon entering our playroom, which is a room with carefully selective expressive toys, including dress-up clothes, blocks, art materials and toy animals.

PMHP enables us to build one-to-one relationships with each child, who expresses a natural language of play by what he or she does with the tools and props. In each play scenario, we reflect on the child’s actions and emotions and help each overcome problems.

As the mental health supervisor for the program, I initiate parent contacts, report on progress and also offer an educational program that encourages parents to play with their children.
This “culture of play” encourages parents to become more tuned to their children, and in the words of one, “the family gets a greater benefit from the program than the child!” In addition, parents who have participated in the interventions are generally easier to work with, less negative about school services, and turn to us more readily if they have concerns.
PMHP is a cost-effective way for our district to use its limited mental health resources. One child associate can effectively provide intervention for students with mild difficulties, and help them become more at ease and self confident in school. And our school psychologist and I can work with students who need intensive support or alternate approaches.

This project warrants consideration by other district administrators who, like Migliori, take seriously the research that demonstrates the value of early intervention, and who understand the powerful link between school-related competencies and social emotional health.

Kathleen E. Eisele is a school social worker in the Westmoreland (N.Y.) Central School District.

Children’s Institute

National Registry of Evidence-based Programs and Practices

Promising Practices Network

Substance Abuse and Mental Health Services Administration (SAMHSA)