The aim of this historical survey is to present a well organized statement of the activities of the play therapy clinic at the College of the Pacific and to analyze and evaluate the findings . One year after the origin of the clinic , there was felt the need for a survey. The writer has had many opportunities to observe the functions and the operation of the clinic, and he has felt that the activities and objectives of the clinic should be defined clearly in writing so that the beginning students at the clinic may have a more adequate approach to the clinical situation. Each semester, the psychology department admits more newer students who are majoring in the field. It is the writer's hope that this survey might add to the effectiveness of the training program in play therapy and that the new students might use this survey to their advantage, and perhaps it might shorten the time for them in comprehending the clinical activities and in understanding its functions. It is not the intention of the writer to solve all the problems of the clinic, but it is his interest to point out the various problems in the clinical situation for further study. The writer also feels that the data obtained from this survey would be valuable to the clinic for its self-appraisal. This survey will also have a practical value to the College of the Pacific and to the students who are majoring in psychology who are contemplating taking the course in play therapy, and also to those who want to know something about the nature of the program.

Background. Autism spectrum disorder (ASD) is characterized by persistent difficulties with social communication (American Psychiatric Association, 2013). Due to the high prevalence of ASD there’s a significant demand for services to support these individuals and the involvement of caregivers is considered a crucial element of effective early intervention for young children with developmental disabilities (Siller & Morgan, 2018). The Incredible Years ® is an evidence-based behavioral parent training program with a large body of research demonstrating its efficacy with enhancing positive parenting practices during parent-child interactions for children with behavior problems (Menting et al., 2013). The program is built on the foundational concept of child-led free play. Recently, the program has been adapted for families with young children with developmental disabilities, Incredible Years Program for Autism Spectrum Disorder and Language Delays Ages 2-5® (IY-ASLD). IY-ASLD aims to help parents learn developmentally-attuned language and play strategies to effectively engage with toddlers with ASD or social communication delays. There are few published evaluations of IY-ASLD currently. However, the findings from pilot studies are promising in terms of the feasibility of implementation, with high levels parent satisfaction and attendance. The present study uses data from a pilot study of the IY-ASLD program (N=17), which was adapted to telehealth during COVID-19 pandemic with the assistance of program developer. This dissertation contributes to an emerging body of research by evaluating the IY-ASLD program in a community setting. By examining IY’s group treatment model in a telehealth format, we also gain valuable insight about virtual parenting interventions, which have the potential to significantly expand treatment to more families. Methods. Families were recruited from a specialized early intervention and preschool program that utilizes an Applied Behavior Analysis approach to education. Seventeen (N=17) parent-child dyads from the school enrolled in the program. All or virtually all children referred to this school by their school district are at-risk for or have been diagnosed with ASD. All of the children had an IEP or IFSP with mandated speech services, 71% of the children met criteria for ASD (N = 12) on the Childhood Autism Rating Scale-2-SF, and 2/3 of the sample had adaptive behavior composites below a standard score of 70 on the Vineland Adaptive Behavior Scales- Third Edition Comprehensive Teacher Form (Sparrow et al., 2016) at baseline. The parent participants, all mothers, began and completed a 12-week IY-ASLD telehealth intervention delivered over HIPAA protected Zoom. Mothers were from diverse backgrounds (41% non US born), well-educated (94% college graduate) and had a high median household income. Data from participants was gathered through questionnaires administered to parents, child-functioning measures completed prior to treatment by school personnel, and parent-child interactions videos recorded in the home at pre-, mid-, and post-treatment across a 12-week IY-ASLD intervention. Primary outcome variables were parent verbal behaviors during 5-minute parent-child free play sessions recorded at each time point. Each vocal utterance during free play sessions was coded for function, consistent with the parenting skills that were targeted in the IY-ASLD program (e.g., reducing commands, questions, and corrections, increasing descriptive narration and praise, following the child’s lead). The independent variables were time and dosage (minutes spent in treatment) and the moderators were child’s functioning levels (special education teacher/clinician ratings on the Vineland Adaptive Behavioral Scales- Third Edition (Vineland-3, Sparrow et al., 2016) and Childhood Autism Rating Scale, Second Edition- Standard Form (CARS2= ST, Schloper et al., 2010). Results. Mothers in the IY-ASLD program significantly decreased the ratio of parent-directed language and increased the ratio of child-directed language they used during the free play sessions with large effect sizes and most of the change occurring in the mid-to-post interval. Descriptive statements (tacts) also increased significantly for all participants with large effect sizes; the number of directive or question statements (mands) decreased with medium effect sizes, though the results were not significant. Dosage was not a significant predictor of outcomes at post-treatment when pre-treatment parenting behaviors were taken into consideration, possibly due to low variability in attendance. When child level was analyzed as a moderator, there were large effect sizes for the observed changes in tacts, mands, and overall ratio of child-directed language when children were divided into ASD vs No ASD groups, but small effect sizes when looking at low vs high adaptative behavior groups. There was a significant interaction effect between change in parent language over time and ASD severity of the child; parents of children with ASD did not significantly reduce the number of mands over time, while parents of children without ASD significantly reduced their number of mands over time. This research provides support for a full-RCT of IY-ASLD in this setting, suggesting that the intervention promotes maternal use of child-directed language, particularly for children with language delays as opposed to those with more severe symptoms of ASD. Interventions such as IY-ASLD may help empower parents of preschoolers with disabilities with strategies to facilitate more rewarding free play interactions at home.

The current study sought to explore play therapists' barriers to engaging parents in their clinical work as well as understand the relationship between play therapist characteristics and their attitudes toward parents. Using a demographic questionnaire, Therapist Barriers to Engaging Parents (TBEP), and the Counseling Self- Estimate Inventory (COSE), 136 members of the Association for Play Therapy were surveyed to explore predictors to engaging with parents. Overall, play therapists reported low scores on barriers to engaging parents indicating play therapists are likely to report positive attitudes toward working with parents. Through two multiple regression analyses measuring the predictive value of self-efficacy subscales including Dealing with Difficult Clients and Counseling Process, play therapist identification as a parent, years of experience, and hours of training on parent engagement, both models demonstrated statistically significant findings with large effect sizes. This study found that play therapist self-efficacy was the strongest predictor of play therapists' attitudes toward parents accounting for approximately 80% of the variance in the models. Play therapists' identification as a parent as well as years of practice also predicted their barriers to engaging parents. Hours of training in parent engagement had no relationship to TBEP scores. Implications for practice include a need to provide play therapists with training experiences that involve working with parents directly rather than traditional training models, as well as attend to general counseling self-efficacy of play therapists. Implications for future research as well as limitations are discussed.

The purpose of this research was to critically analyze relevant literature regarding the effects of preoperative education on levels of stress in the pediatric population. The goal of this research is to review and analyze the available literature to determine best practice as it relates to educating the pediatric preoperative patient in order to relieve stress. Research was retrieved from Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and MEDLINE-EBSCOhost databases using keywords pediatric, preoperative, anxiety, stress, fear, children, hospitalized child, education, play therapy, and surgery. Inclusion criteria included research that focused on relieving anxiety or stress in the pediatric surgical patient. Seven research-based articles were found that met the inclusion criteria. Findings indicate surgery is stressful in pediatric patients at all developmental stages. Preoperative education was found to reduce this stress. Verbal, written, and visual means of education all led to a decrease in stress prior to surgery. More research is needed to determine the best developmentally appropriate educational program to relieve stress in the pediatric patient.

Aim: To evaluate the efficacy of therapeutic play in alleviating pain or anxiety in the pediatric cancer patient. Background: Therapeutic play is an intervention often incorporated within the care of pediatric cancer patients and children with other disease processes to promote well-being. Even though play therapy is supported by research, nurses have the option to implement nursing care interventions in a play-like manner. Therapeutic play is an individualized technique that provides an intentional opportunity for children to express their emotional responses in a controlled environment. Method: The databases used in this search included CINAHL, MEDLINE, APA PsycINFO, ERIC, and Education sources. A total of 59 articles were kept for review. One additional article held for review was obtained through a secondary search of the same databases listed. Articles that did not specifically address cancer were not included. Key Issues: Including therapeutic play interventions in the treatment of pediatric oncology patients is not a mandatory practice. If nurses perceive play therapy as an effective treatment option, an increased value may be placed on the approach. The usefulness of the intervention and the nurse's ability to execute it is essential in determining the overall efficacy. Conclusions: Therapeutic play contributes to many favorable outcomes when used in practice during pediatric cancer treatment. While the reduction of pain and anxiety is supported, other beneficial effects include increased positive coping mechanisms, patient satisfaction, compliance, self-efficacy, social skills, and improved communication. Keywords: Therapeutic play, play therapy, cancer, oncology, pain, anxiety, pediatric, nurse

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Bakgrund: Rädsla och oro är vanligt förekommande hos barn som ska genomgå generell anestesi i samband med operation. Detta innebär både ett direkt lidande för barnen och resultera i dåliga erfarenheter för framtida sjukvårdsbesök, men kan också medföra stora utmaningar för anestesisjuksköterskor. Av den anledning har flera metoder testats och studerats för minska barns preoperativa rädsla och oro, varav lekterapi är en sådan metod. Syftet: Att granska och sammanställa vetenskaplig forskning kring effekterna av lekterapi som ett verktyg för att minska preoperativ rädsla och oro hos barn som ska genomgå generell anestesi. Metod: En systematisk utförd litteraturstudie med narrativ syntes, som uteslutande inkluderar randomiserade kontrollerade studier (RCT). Databaserna PubMed och Cinahl har använts för att söka tidigare studier och totalt 14 randomiserade kontrollstudier har inkluderats i studiens resultat. Huvudresultat: Tio av de granskade studierna visat att lekterapi kan ha en positiv effekt på barns rädsla och oro i samband med generell anestesi. Fyra av de granskade studierna visade på tvetydiga resultat och/eller resultat som inte var statistiskt signifikanta.  Slutsats: Det finns stöd i forskningen för att relativt små förändringar i den preoperativa vården, såsom lekterapi i några minuter, kan bidra till stor skillnad för vårdkvaliteten. / Background: Fear and anxiety are common among children undergoing general anesthesia for surgery. This not only directly affects the children but also results in negative experiences for future healthcare visits, and can pose significant challenges for anesthesia nurses. For this reason, several methods have been tested and studied to reduce children's preoperative fear and anxiety, with play therapy being one such method. Aim: The aim of this literature review is to examine and compile scientific research on the effects of play therapy as a tool to reduce preoperative fear and anxiety in children undergoing general anesthesia. Method: A systematically conducted literature review with narrative synthesis, exclusively including randomized controlled trials (RCT). The databases PubMed and Cinahl were used to search for previous studies, and a total of 14 randomized controlled trials have been included in the study's findings. Main results: The main result of this study shows that ten of the reviewed studies demonstrated that play therapy can have a positive effect on children's fear and anxiety associated with general anesthesia. Four of the reviewed studies showed ambiguous results and/or results that were not statistically significant. Conclusion: The conclusion of this literature review is that previous research indicates that relatively small changes in preoperative care, such as play therapy for a few minutes, can make a significant difference in the quality of care.